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3 • 4 



THE NEW UBRARY OF MEDICINE 

EDITED BY C. W. SALEEBV, M.D., F.R.S.E. 



DISEASES OF OCCUPATION 



DISEASES 
OF OCCUPATION 

FROM THE LEGISLATIVE, SOCIAL, AND 
MEDICAL POINTS OF VIEW 



lY 



THOMAS OLIVER. M.D., F.R.C.P. 

FaTMOAM, mOIU. VlCTOaU IHTOIURV, HBWCilSTLK-UPOM-TTM : 

ntonHos Of ^uoLoaT, ddkhaii mivmam 



SECOND EDITION 



METHUEN & CO. 

36 ESSEX STREET W.C. 

LONDON 



Pint PuUiiiiJ . . Maitk, 1908 

Sccoad Ediliau , igoS 



PREFACE 

IN ° Diseases of Occupation " I have endeavoured to place 
before the general and professional reader iin(iortant 
facts dealing with the effects of industries upon health. The 
subject is one which within the last few years has attracted, 
and in the future is still likely lo attract, considerable 
attention. The health of the nation must be viewed firem 
all standpoints, and as the working-classes form the laigest 
proportion of Ihc population the conditions under which they 
labour call for thoughtful study. I am hopeful that this 
b<x>k will prove useful to Members of Parliament, to all 
persons interested in schemes for social betterment, to 
medical officers of health, and to members of the medical 
profession generally. 

To the authorities at the Home Office and especially to 
Dr. Whitclcggc and Dr. T. M. Lcggc I take this opportunity 
of acknowledging the great assistance [ have received from 
the Annual Rcjjorts of the Chief Inspector of Faclorie-t. My 
thanks are due to M. Le Clerc de PuUtgny, of the Minist^re 
du Travail, Paris, for his unvarying kindness and his genial 
companionship in my visits to French factories ; also to Mr, 
I. H. L. Van Dcinsc, of the Netherlands Factory Department, 
and to Dr. G. Waller, of Amsterdam. To Professor Bcdson 
and Mr. Bclger, of the Armstrong College, Newcaiitle-upon- 
Tyne; and to Drs. R. A. Bolam and Alfred Parkin I am 
indebted for help always cordially given. 



Thomas Ouver 



Ellison Pljice 

NBwcAsrtx-VPOK-TrriE 



M389Z 



CONTENTS 

CHAPTUl PACB 

iHTRODUCTORy ..... ix 

I. Factors Contributing to Industrial Diseases 

AND Accidents . , , . . i 

II. Diseases Due to Gases, Vapours, High Tem- 
peratures, etc. . , -54 

III. Diseases Dub to Working in Caissons and 

Compressed Air , . .88 

IV. Diseases Due to Diminished Athosphbric Pres- 

sure ...... 115 

V. Chemical Trades . . .120 

VI. Explosives and the Effects upon Health bv 

the Gases Evolved . . .130 

VII. Diseases Due to Metallic Poisons, Dust, 

Fumes, etc . . '37 

VIII. Diseases Due to Metallic Poisons, Dust, 

Fumes, etc. {Cantinued) .316 

IX. Diseases Due to Organic and Inorganic Dust, 

Heated Atmosphere, etc. 343 

X. Mining ...... 267 

XI. Diseases Dub to Parasites and Microorgan- 
isms ...... 313 



viii DISEASES OF; OCCUPATION 



3S8 



XII. DANGZKS AriEHUAHT UPOH THZ C^HEXATION AND 

Uses or KLKCTucmr attd Electric Welding 347 
XIII. Diseases thk Consequcmcs or Fatigue; Occu 

PATIOM NKUKOSES 

XIV. Diseases in MisccLLAMaoas Trades ard Occu 
PATIOMS • • . . . 

XV. Soldiers, Sailors, and Fishermsh 

XVI. Rescok Work in Mines 

Index. ..... 



366 

393 
400 

413 



ILLUSTRATIONS 



FHL 



I. Ankylostoma Duodbnale (Human, Natural Size) 332 

a. „ f, (Human, x 13 Diaus.) . 323 

3, „ „ (Human, Conjugation, 

X 7 DlAMS.) . 322 

4, Ankylostoma Caninuh (Ova of, x 300 Diameters) 322 

5, „ „ (Larva of, x 300 Diahs.) . 332 
(7>w. Jtffyai Society, Edim., Vol. xxv, Pt. «. T. Oliver.) 



INTRODUCTORY 



THE subject of Diseases of Occupation is so iiitimaiely 
associated with the operation of the factory laws, that 
in order to study the one we must know something of the 
other, Factory legislation has been in the main devised to 
protect the health of the workpeople and to safeguard their 
interests. 

It Is a far cry from i8oz. the date of the rise of factory 
legislation in this country, to the passing of the Workmen's 
Compensation Act in 1906. Within these years are included 
all that is known of factory legislation and what it has accom- 
plished. Before the dawn of the eighteenth century the 
lnc)ii!«triAl Revolution had already ultercd the conditions of 
life and labour in Great Britain. The substitution of steam 
for water power further changed those conditions, so Chat the 
health of tlw workpeople necessarily became a matter of 
State concern and State control. Labour flocked to where 
machinery was most active. Since then may be dated the 
rise of modem towns and the depiction of rural areas. It 
was toon found that machinery could be worked by young 
and, comparatively speaking, unskilled hands, hence came 
the demand for women's and children's labour. Factory legis- 
lation at its inception was in the main concerned with those 
who could not take care of themselves. The exploitation of 
child labour is a harrowing story, and one of the dark spots 
on the page of the industrial history of our country. It is to 
*e credit of Great Britain that she was the first to move in 



DISEASES OF OCCUPATION 



I 



the matter, and thus became the pioneer of industrial legists 
tion. Since then decade after decade has witnessed a succes- 
sion of Factory Acts and Labour Laws based upon experience 
and necessity. It might have been expected that at the end 
of a centuiy of experience and progress industrial evolution 
would have reached such a degree of excellence and attained 
to such a standard of hygienic perfection that little more 
would require to be done; Not so, however, for the subject 
l» endless. Each succeeding decade brings its own problems 
for solution, and each new invention imposes its own special 
trials upon producers. Child labour wa.s fostered by parental 
greed and poverty, and was encouraged by employers. 
Although Great Britain has, practically speaking, abolished 
the iniquity, child labour still lingers in several of our home 
industries, and is not unknown in other countries. It is only' 
within the last quarter of a century (1886), for example, that' 
the first Factory Act was passed in the State of New York. 
There, as here, factory legislation began with child labour 
and female labour questions, and the compelling agents were 
the working men's trades unions and philanthropic societies. 
The reproach is sometimes levelled at trades unions that 
their interference with children's and women's labour has not 
been altogether disinterested, since by raising the age for ^ 
commencing work they have diminished the numbers oCfl 
children employed, and by checking female labour they have 
kept up the standard of wages and given more work to men. 
In the United States there is a greater tendency to bring 
labour questions within the range of politics than in Great 
Britain. Organised labour and capital have more power 
tiiere than here. By the Factory Act of 1 886 no child was 
allowed to work in New York State under thirteen years of 
age; since then the minimum age has been raised to four- 
teen. The drawbacks to child labour are that children are 
deprived of Icisnre and freedom in the open air, and are sub- 
jected to a monotonous life when they ought to have variety. 
The physical effects are those of degeneracy, as seen in 
stunted growth and impaired nutrition, while of the moral' 
effects illiteracy and its consequences arc the more immc 
diately apparent 



INTRODUCTORY 



XI 



Factory legislation has been a gradual restriction of the 
freedom of the indii'idual and of his subjection to State 
control. The events which stand out prominently in the 
industrial legislation of last century are. in addition to the 
curtailment of children's and women's laboiir, shortening of 
the hours, improvement of the conditions under which labour 
generally is carried on, hygiene of dangerous trades, restric- 
tion of the power of employers, and the transference of this 
power to oi^;ani3cd labour. In factory work individualism is 
subordiT\ated to general requirements. Theoretically there 
is nothing to prevent a man in his individual capacity work- 
ir^ as long as he chooses, but there is no place for such 
personal action in the corporate life of a factorj-. The con- 
ditions do not admit of this. It is not maintained, for 
example, that by working longer than eight hours a day a 
man's health is injured, for experience 'proves the contrary, 
but it is held that no employer has the right to utilise the 
whole of the working part of a man's day, and thus deprive 
him of the leisure to which he as a human being is entitled. 
Since his whole nature has to be dc^xlopcd, it is claimed that 
the intellectual, moral, and physical powers of man cannot be 
developed if the hours of employment are tcx> long, the work 
too hard and of a grinding nature. Nor must the hours of 
labour l>e the same for all trades. There are some, such as 
the textile industries, work in shipbuilding yards and iron 
works, coal mining, and several artisan trades, in regard to 
which a common basis of agreement can be arrived at as to 
whether the number of hours of work should be eight or nine. 
In trades that are dangerous to health tlie hours should not 
be long ; and in the textile industries as the speed of 
machiner)' i« quickened and the nervous ten.sion upon the 
worker becomes greater the hours of labour should be 
proportionally reduced. 

Shortening of the hours of work per day and the Saturday 
afternoon holiday hivc given the working classes more 
Idsurc, while improved conditions of labour in factories, 
fencing of machinery and hoists, abolition of night work for 
women and children, better provision of sanitary conveniences 
lor the workers, and better education generally have done 



xii 



DISEASES OF OCCUPATION 



much to raise the working classes to a higher platform of 
comfort as well is to one of discontent It was apparent 
that the conditions of labour that prevailed before the 
passing of the first Factory Act could not be allowed to 
continue. There was a waste of human life which had to be 
checked and a physical dq^eneracy and ignorance which had 
to be stopped. No tongue can tell the saving of human life 
that has been effected by the Factory Acts. At present each 
fatal accident is carefully investigated, and the circumstances 
attendant upon each death in a trade belie\-cd to be dangerous 
to health arc carefully sifted so that further fatalities may 
be averted. These precautionary methods have only been 
arrived at as a result of the death of many poor a.nd 
unknown men and women whose lives were sacrificed that 
the life of others might be saved. 

Industrial problems in their medical aspect not only con- 
cern society, in many instances they control the future of 
the race, as witness the employment of women during preg- 
nancy and after confinement, also the baneful effects of lead 
upon motherhood. All work should ennoble, and yet there 
arc certain trades that tend more to degrade man than raise 
him, as witness the work of the iron puddlcr. The cheerless 
days, too. spent in a textile factory amid the din of 
machinery, and the monotonous character of the work, are 
not such as of themselves to quicken the intellect and pro- 
mote the higher interests of life. Is it not rather that they 
tend, through the strain they cause, to encourage a craving 
for that form of recreation which seeks an outlet in excite- 
ment and pleasure, and, on the other hand, to dishearten 
men and women who, as factory operatives, feci that they 
cannot rise to a higher occupation than that of minding 
machinery? TTie despotism of -•vome branches of modem 
labour is overpowering. Factory legislation has done some- 
thing to minimise this. The present age is marked by social, 
benevolent, and parliamentary schemes which are meant to 
dispense industrial justice and to provide greater personal 
opportunities. To be of helpful service factory legislation 
must be progressive and keep pace with the industrial 
problems special to each succeeding age; 



INTRODUCTORY 



XIII 



Tkt Rise and Progress of tkt Ftutcry System 

The Pcd Act of 1S02 was passed to preserve the health 
aod morals of apprentices and others employetl In " cotton 
and other mills and factories": the rooms of the factories 
were to be washed with quicklime and water twice a year, 
i^ht work was prohibited, the hours of work were to be 
twelve per day. the apprentices were to be instructed in 
reading, writing, and arithmetic every working day for the 
fint four years, and in the principles of the Christian religion 
on Sunday. The factories and mills were to be visited by a 
justice of the peace and by a clergyman. Although not a 
Factory Act in the usual acceptation of the term, but simply 
an extension of the Elizabethan Poor Xjaw relating to parish 
apprentices, and therefore likely to fall short of the actual 
requirements of the lime, it was something to have succeeded 
b getting a few of the principles of factory legislation recog- 
flbed, such as the limitation of the hours of work. The Bill 
passed without serious opposition from the manufacturers. 
It was otherwise when, later on, fresh factory legislation was 
attempted- In 1816. on Sir Robert Peel's proposition. Par- 
liament caused an Inquiry to be made into the condition of 
the factory population, and three years afterwards powers 
were conceded to the Government to limit the age at which 
children should be admitted into factories. When in 1833 
Lord Ashley inaugurated the industrial and social reforms 
with which his name is associated, and by which it was 
sought to limit the working hours of children under thirteen 
to eight hours a day, and girls under eighteen to twelve 
boars a day, employers and several members of the House ol 
Commons urged that Parliament was exceeding its duty in 
attempting to restrict the hours of labour. At this period 
the infant death-rate was high. One half of the children 
bom in Manchester died under three years of age, and in 
factory ton-ns the youthful population was physically worn 
out before manhood. Four inspectors had been appointed to 
see that the factory laws were obeyed throughout the country. 
Power w»s given to these Government officials to enter fac- 
lories at any hour and to examine the workers. The employ- 




XIV 



DISEASES OF OCCUPATION 



■* 



mcnt of children under eight years of age was prohibited, 
women's labour restricted by the 1844 Act. The following 
year witnessed the passing of Lord Ashley's Print Works Act. 
A demand for shorter hours of labour was also rai^d. In 
1II47 the Ten Hours' Bill was passed, and by it the working,^ 
time for women and children was restricted to ten hours 
day ; it was also arranged that the workin(; day was to be 
the period between 5.30 a.m. and S p,ni. In KS54 the fencing 
of all shafts was made a requirement, but not without con- 
siderable opposition from a section of employers. The Act 
of 1853 limited the working time for children to the period 
between 6 a.m. and 6 p.ni. In 1864 certain trades were 
scheduled as unhealthy, and regulations were issued bearing 
upon ventilatioiL Under the 1864 Act were included 
earthenware and other manufactures. Removal of dust by 
fans was required by the Act of iSG/ both in factories and 
workshops. Three years later bleaching and dye works were 
brought within factory law. The Act of 1878 forbade chil- 
dren to work in certain processes of white lead manufacture. 
This was the first Consolidating Act It was passed after an 
exhaustive inquiry by a Royal Commission, and was followed 
by a scries of Amending Acts : that of 1883, in which were 
embodied Special Rules for white lead factories and bake- 
houses; of 1891, in which were included Special Rules for 
dangerous trades, notification of accidents, and the abolition 
of the employment of children under eleven years of age ; of 
189s, whereby laundries were brought within the sphere 
factory inspection, and rules were made applicable to docks ; 
while the Act of 189^ dealt mainly with cotton, cloth, and 
other factories. 

Until 1891 workshops had not been included under all 
the provisions uf the Factory Acts; the difference between 
the two places lay tn the use of motive power in factories. 
The Factor)' Act of 1891 repealed the special exemption 
enjoyed by women's workshops and extended sanitary 
regulations to workshops in which only adult men are 
employed. The main "design and object" of this Bill 
"was to bring all workshops and factories up to the same 
sanitary level." To local sanitary authorities was entrusted 



INTRODUCTORY 



XV 



the supervuion or the sanitary condition of the workshops, 
*nd although to give this effect special inspectors of work- 
shops for certain large towns were appointed it cannot be 
said that the dual control was an unqualified success, owing 
to the fact thai local authorities too frc<iut:ntly- shirked 
their responsibilities. By the Act of 1901 increased powers 
were given to local authorities, and medical officers of health 
were called upon to keep registers of the workshops in their 
districts and to report upon them annually. 

It Is rc(]iiircd by the factory laws that all dangerous 
machinery shall be fenced, safety valves and steam gauges 
be provided on steam boilers, that IxMlers be examined by 
an expert and reported upon once in every fourteen months, 
and that no machinery in a factory sliall be cleaned by a 
child when the machinery is in motion, nor shall a young 
person dean any dangerous part of mill gearing. Women 
arc also forbidden to clean mill gearing while the machinery 
is in motion. Fire escapes must be provided. At present 
DO diild under twelve can be employed in a factory or 
irork&hop. The Act of [878 allowed children to bcemployed 
at the age of ten; the Act of 1891 raised the age to eleven ; 
and now no child can be employed under twelve. To the 
Home Secretary has) been given greater power for the 
rcgularion of dangerous trades. In Great Britain Sunday 
employment is forbidden. 

The last decade of tlic nineteenth century and the com- 
mcnccmciu of the present have been marked by the appoint- 
ment of several Departmental Committees of (he Home 
Office. As 1 had the honour and the privilege of sitting as 
a member on a few of the Committees appointed to inquire 
inlo the effect of certain industries upon the health of the 
workpeople, to that circumstance and to the experience 
gained as a hospital physician must be attributed the raison 
^itrt of this contribution to the subject of factory legisla- 
tion and occupation diseases. 

The work of the Factory Department of the Home Office 
has enormously increased within the last few years, and 
recent legislation tends still further to Increase it. B^inning 
with four factory inspectors in 1833 there are now upwards 




XVI 



DISEASES OF OCCUPATION 



of 170 all told in the department. The appointment < 
special inspectors has been most useful. It is only within 
recent years that female inspectors have been employed, but M 
the excellent work done by the Principal Lady Inspector of" 
Factories and her stalT of ladies lias more than justified the 
creation of this particular section of the department M 

Into the details of the Workmen's Compensation Act of" 
1906, which is an extension of the Act of 1897. I do not 
propose to enter. In this country indu<itrial legislation iafl 
based upon experience and expediency, so that no sooner is an ™ 
Act in operation than its weak ix>int.s become apparent and 
a fresh Act is required to remedy defects and remove flaws, M 
but it too generally ends in introducing controversial matter 
and in providinj; employment to lawyers and doctors. The 
Workmen's Compensation Act of 1906 repeals the Acts offl 
1897 and 1900, and it extends the principle of compensation " 
to all classes of persons engaged under contracts of service, 
including domestic servants and sailors. In addition, by 
including certain defined trades, it makes employers liable to 
pay compensation for diseases arising out of and in the 
course of employment. By a " workman " is meant " any 
person who has entered into a works under a contract of 
service or apprenticeship with an employer, whether by way 
of manual labour, clerical work, or otherwise, and whether 
the contract is expressed or implied, is oral or in writing." 
Certain persons arc outside the .'Vet, e^., policemen, persons 
in the naval and military services, profit-sharing fishermen, 
non-manual workers whose remuneration exceeds /^2SO a 
year, and others. The Act is comprehensive and includes 
most trades and lowly-paid members of professions, among 
which are mentioned house-surgeons and hospital nurses. 
It also includes certain industrial diseases, the consequences 
of which may be immediate or remote and which are often 
more severe than accidents. A workman is entitled to com- 
pensation if he is incapacitated by a disease contracted in his 
trade and due to his employment exactly in tlie same way as 
if he had been thrown Atfrs tte combat by an accident. The 
following have been scheduled : Poisoning by nitro- and 
amido-derivatives uf benzene or its sequelx, carbon bisulphide 



J 



INTRODUCTORY 



XVII 



or its seqtielx, nitrous fumes or sequela:, nickel catbonyl 
or sequelic, arsenic poisoning or sequela:, lead poisoning, 
African boxwcxxl or sequelx, chrome ulceration or sequelae, 
■keratkms produced by dust or caustic or corrosive liquids, 
cancer or ulceration of skin or of corneal surface of eye due 
to pitch, tar. or tarry compounds, chimney sweeps' cancer, 
nystagmus, glanders, compressed-air illness or its sequelae, 
beat hand (subcutaneous cellulitis) of coalmtncrs, miners' 
beat knee and beat elbow, and inflammation of the synovial 
lining of the wrist-joint and tendon -sheaths of miners. In 
order to claim compensation a workman must produce (l) a 
certificate from the local certifying factory surgeon, (2) or 
prove that he had been suspended from hi? usual employ- 
ment on account of havini; contracted one of the diseases 
scheduled, and (3) in the event of death proof will have to 
be given by friends or dependants that death was due to one 
^of the diseases mentioned above, 

^B It is generally conceded that the effect of the factory laws 
^Bks been to improve the condition of labour in factories, to 
promote the health of operati%-es, to reduce the hours of 
labour, and to give the workpeople often healthier and more 
sanitary surroundings than they have at home. Much yet 
requires to be done, for factory life is not always so satisfactory 
as at fJrst sight it appears. It is said that factories existed 
in Greece, Rome, and in the older civilisations, but these 
establishments were not factories in the sense wc know them. 
The men, women, and children who worked therein were 
slaves, and their work was carried on under the eye of task- 
masters. The factory system of Great Hritain was the 
neeessary consequence of the introduction of machinery and 
the massing together of lai^e numbers of work |}cop!c in mills 
and lactones. The first factory of modem type was buitt by 
Sir Thomas Lombc, in 1719, in Derbyshire, for the manufac- 
ture of silk. Other establishments soon followed, but many 
of them were of rude description, and in these the employes 
worked long hours, little regard being paid by the masters 
to the health of the work[)eop!e. It was the age of Utisas 
faire. There was no limitation as to hours of labour, the age 
of workers was not defined, there was little consideration 

A" 




xnii 



DISEASES OP' 



IPATION 



i 

i 



shown to femate workers, and no regard for health generally. 
Factory legisUtion has altered all these, and while the trend 
of industrial methods is in the direction of increasing the 
speed of machinery, and therefore of taxing still further the 
nervous energy of the workpeople, there is greater respect 
for the health of the workers and for their comfort than 6fty 
years ago. The factory system has its defects. It is ui^ed 
against modem industrial methods that they allow female 
labour and that as consequences of the increasing employment 
of women there arc ensuing a weakening of home interests 
and a neglect of home duties. Where both parents work in 
factories, as in the cotton mills in I^nca-shire, there is little 
home life. The young children are taken from their warm 
bed in the early morning and carried by the mothers to a 
caretaker, usually an elderly female, with whom several 
children are left for the day. At the end of the day's work 
the mother calls on her way from the factory for her infant 
and proceeds to her home, all dark, cold, and cheerless, for 
Che shutters have not been opened, the fire has not been lit, 
and no evening meal awaits tliem. Of home life for textile 
workers where both parents go to the factory there is almost 
none All is made subitervient to the feqtitrcmcnts of the 
factory, whose incessant demands sap all that is best of 
&mily life and maternal instinct fl 

While there is doiibtle-ts much to condemn in the factory^ 
system there is also something to be said in its favour. { 
Under the heading " Factory " in the American supplement I 
of the " Encyclogxedia Britannica,'" Mr. Carroll D. Wright, I 
formerly Chief of the Bureau of Labour Statistics in 
Massachusetts, says that while by no means perfect, tho 
factory system is in advance of previous methods of produc- 
tion, " The evils which were apparent during the early days 
of the factory system were simply the result of bringing 
together the labour which had become pauperised under the 
domestic system and in agricultural di:«tricts. . . . The factoi 
haa not so much destroyed the home as tt has enabled 
members of broken families to earn a livelihood. If it has 
at times taken the mother from the care of her young 
children — the worst feature of the employment of married 



. I 

theU 
1.^ ^ 



INTRODUCTORY 



XIX 



mmen — It hss enabled more who had no home to be 
■elf-xupfjorting." It is claimed for tht; TActory sy^ttem that 
rather than tending^ to degrade, mentally or physically, 
ttiosc brought under its influence, tt has raised the lower 
chiwe^ and improved their scale of living. Because better 
machinery has enabled less educated persons to engage In 
and accomplish what formerly required skilled labour, this 
fiut docs not necessarily imply that the work has degraded 
skilled labour. Tor it may have lifted the unskilled. Things 
were undoubtedly bad when the factory system was insti- 
tuted. While it displaced many evils, several have beea 
retained, some of which are only gradually being eliminated. 
Many of the present defects in our factory life and methods 
Am thcrcrorc to be considia-cd as less the result of the system 
than the outcome of want of knowledge on the part of the 
workpeople, and of an unwillingness on the part of employers 
to recognise the fact that capital has duties as well as rights. 




DISEASES OF OCCUPATION 



CHAPTER I 

^FACTORS CONTRIBUTING TO INDUSTRIAL DISEASES AND 

■ ACCIDENTS 

^VK T O mattcT what parliamentary legislation may eoacti 

1\| industrial hygiene will never be secured until the 

workers thenaselves are educated in regard to the dangers 

inddcntal to particular trades and arc willing to co-operate 

in making Home Office regutiLtions effective. There must be 

. a greater amount of mutual trust and a heartier co-operation 

of employers and employed. Only thus is it possible to 

remove the stigma that attaches to many occupations and 

the cause of their unheal thincss. No person should be 

employed in a dangerous trade until the risks have been 

' explained to him by the employers and the means indicated 

I whereby danger to health may be averted. Of the conditions 

' met with in factories that contribute to industrial diseases 

mention may be made of imperfect ventilation, absence of 

means for the withdrawal of dust, imperfc-ct supervision of 

the workers, and inadequacy of washing appliances. Want 

of cleanliness has long been recognised as an important 

' contributing factor, especially when combined with poverty, 

^ deficient food and clothing, and improper housing. Sex 

Bk in some instances a predisposing circumstance, as, for 

^pxamplc, in the greater liability of women to plumbism and 

Ho the rarer types of the malady than men. Age, too, is not 

without its influence, for experience has shown that young 

adults of both sexes are more predisposed to lead poisoning 



I 



I 



DISEASES OF OCCUPATION 

than persons of raaturer years. The bad effects of over- 
crowding and of sleeping in ili-vcntilatcd rooms are seen in 
the readiness with which fatigue is induced and tn the 
inability of workers thus imperfectly housed to keep pace with 
their heaJthicr comrades and the increased speed at which 
machinery is run. It is largely owing to the influence of 
fatigue that, as the day proceeds, the workers, becoming tired 
in mind and body, become careless, and as a consequence the 
number of accidents increases with the hours of toil. As a 
result of general fatigue the exhausted and overheated work- 
man on leaving the factory is tess resistant to the weather, 
and readily catches cold. In a similar manner groups of 
over -worked muscles readily become paralysed, compared with 
other muscles that are not so constantly in action. Knowing 
this fact, hoiisc-pa inters, by educating themselves to use both 
hands, become less liable to " wrist drop," There arc certain 
people, the victims of an inherited weakness of the nervous 
system, the subjects of neurasthenia, others again the subjects 
of ana:mia or blood lessness, who through sheer physical 
inability arc unable to do an ordinary amount of work and 
who are more quickly laid aside by industrial disease than 
others. Where the work is hard, and heavy weights have to 
be lifted or carried, the effect of such strain may show itself 
in rupture of a blood-vessel, the formation of an aneurism, 
dilatation of the heart, rupture of muscle, strained tendon, 
or hernia. The habits of the workpeople, too. are not with* 
out an important bearing upon their freedom from or their 
liability to industrial diseases. There is nothing that induces 
to certain forms of industrial poisoning or is more likely to 
become a cause of accident to a workman than indulgence 
III alcohol. An intemperate man is only courting disaster 
when he continues to work, for example, in a white lead 
factory. Apart from the imperfect character of the workman- 
ship, the excessive use of alcohol makes a man careless 
and heedless of danger ; he runs risks be otherwise would 
not incur, and to this circumstance may be traced many of 
the accidents that happen in docks and wharves, and to it, 
also, probably some of the shipwrecks that have taken place 
shortly after vesads have put to .sea. The excessive use 



I 
I 




INDUSTRIAL DISEASES AND ACCIDEXTS ji 

ofalcoho] is a cause of epileptic attacks in men previously 
free froin fits, and as eptJepsy assumes many forms — for 
example, often only a sense of giddiness or faintncss — it is 
not improbable that some of the unexplained falls of men 
which result in serious injury to life and limb, may be the 
result of ill-nourished, poisoned conditions of the nerv-oua 
system, not the outcome of »n immediate debauch but of 
long-continued indulgence tn alcohol, if we add to alcohol 
the infection of syphilis we have in these a combination of 
circumstances the influence of which, from a medico-legal 
point of view, is far reaching so far as workmen's compensa- 
tion is concerned. 

It is an interesting problem to consider the probable effects 
apon the health of the workpeople in the future of the in- 
creased speed at which machinery is being run in the factories 
and tlie speeding-up of the work in shipyards. That there 
is greater strain upon the nervous system, more exhaustion 
and consequently need for greater leisure, few will deny, and 
that in many instances the hard work induces premature old 
age goes without saying. Will this speeding-up tend to 
make female mill-workers better mothers and help them to 
give birth to bealUiy and robust children, or to infants who 
arc puny, ill-nourished and of a highly strung nervous system ? 
In some American factories in which .stitched muslin under- 
wear is made, so great has been the improvement in the 
machinery of late that the sewing machines are carrying two 
to ten needles inste,id of one as formerly, and as a con- 
sequence many of the girls are no longer capable of the 
sustained cfTort necessary to follow the improved speed, and 
have been obliged to relinquish their occupation. The strain 
of tlie eyes in watching for broken threads, in order to stop 
the machinery, is almost intolerable ; it requires an amount 
of nervous energy and a constancy of attention which the 
operators cannot supply. There is a limit beyond which tlie 
speeding of machinery cannot be run without detriment to 
the health of the operators unless their hours of work arc 
materially shortened. 

Clearly, theicforc, there are occupations, especially the 
textile trades, that tend through sheer strain to wear out 



the body of the worker and induce premature old age. 
These industries may be said to show their baneful effects 
upon the nervous system. In some of the so-called 
dangerous trades there is observed a vulnerability of 
certain organs of the body. Industrial poisoning;, e^.. plumb- 
tsm, is prevented or retarded by the functional activity of 
such of the eliminating oi^ans as the liver, intestines, and 
kidneys. Lead is thrown out of tlie system by the intestinal 
canal and kidneys. The predilection of lead for the liver 
Is largely due to the fact that most of the lead which enters 

_ the body does so by the alimentary canal, whence it is 

y absorbed and carried by the blood to the liver. It is 
abstracted from the blood by this organ and either thrown 
out in the bile or retained in the hepatic cells. Although 
lead has a strong affinity for nervous tissue and induces 
paralysis of the hands, arsenic rapidly causes an acute and 
painful neuriti.s which, like that due to alcohol, is principally 
met with in the legs and feet It is the same with many 
micro-oi^aninms. In the human t}ody each poison hats its 

_ special site of selection and its channel of elimination. 

f tt may be said of the tubercle bacillus, taking this micro* 
oi^anism to illustrate my point, that notwithstanding the 
channel by which it has gained an entrance into the body, 
through the air we breathe, the food or drink we take, 
the tubercle bacillus ultimately finds its way to the lungs. 

t There is a selection for certain organs or tissues of the 
body by poisons and micro-organisms that we cannot 
always explain. 
Falipi*. General Asftects of the Question 
Hurry and absence of repose arc characteristic of our 
^c. Life as a cortsequencc is fuller. We put more into it 
than did our forefathers, but it remains to be seen whether 
in thus spending more we are getting a corresponding 
■^tum, Among ail classes there is both a demand and a 
need for a larger number of holidays than formerly. The 
pace at which we live, and the rate at which the industrial 
machine is run, create a wear and tear far in excess of 



I 



< 



i 



INDUSTRIAL DISEASI 



ACCIDENTS 5 



anything hitherto known. The pressure pervades all forms 
of human activity. Its effects arc seen in the infant whose 
mother has no time to nurse her child, since she must be 
hi the factory; it is felt by the pupil at school, the appren- 
tice, and by the adult well-nigh on till the working day of 
life is done. In many occupations men are old at 55, and 
the )'ears of declining life, which ought to be marked by 
quietude and repose, are frequently shortened, since relatives 
^bave no time to give the personal attention to the old that 
^Bs necessary. Although the introduction of machinery has 
Bcheapencd products and placed more of them within the 
V reach of the poorer working classes, it has not always 
lightened labour. The rate at which machinery is run 
demands greater attention from the workpeople and im- 
poses u[>on them a severe strain. To the artisan classes 
the Saturday half-holiday and the shortened working day 
have proved a boon from a purely physical point of view. 
Gnat as the rush and pressure are in this country, they 
arc even greater in America. An attempt is being made 
to Americanise some of our industries. In the shipbuilding 
yards on the 'ryn*= *"** elsewhere, so hard do the men in 
some departments work that it is impossible for the appren- 
tices to keep pace with there. Not only is tliis "rushing" 
a cause of serious accidents, as a consequence of the hard 
nature of the work and the vigour with which it is sus- 
tained, but (he men themselves arc frequently so tired that 
many of them spend part of the Saturday afternoon in bed. 
When to fatigue is added severe strain the effects may be 
tamentaWc. as. for example, in the use of mechanical drills 
for ship-plates. The implement is very heavy, and has 
iiequently to be held by a workman standing in an awkward 
position. 1 have been consulted by young workmen suffering 
bota cardiac distress, owing tu acute dilatation of the heart, 
consequent upon the use of mechanical drills. In the textile 
trades the speeding-up of machinery is responsible to a lai^ 
extent for the tiredness and poor physique of the female 
workers. Where husband and wife both work in the factofy 
the house is closed during factory hours and the children 
confided to the care of a neighbour for a few pence per 





N 



day. Tir«d after the day's work, and the home unatlraclive, 
recreation is too frequently, but not always wisely, sought in 
music-halls and cheap theatres where, in a vitiated and over- 
heated atmosphere, the op[x>rtun!ty is not given for the 
elimination from the body of the fatigue products fanned 
during the day. 

I have spoken of fatigue products, but what is fatigue? 
Fatigue or tiredness is a sensation, the outcome of a par- 
ticular state of the nervous system, the result of work carried 
beyond the capabilities of the organism. In ordinary 
physiological activity exhaustion is never attained, for fatigue 
is the warning signal. In each of us there is a certain 
amount of reserve force which allows our muscles and nerves 
to be overtaxed at times without injurious consequences. The 
increased functional activity is met by a corresponding im- 
proved nutrition, whereby recovery is secured. Life involves 
change of structure. The waste products added to the 
blood act upon the nerve endings in muscle and upon the 
grey matter of the brain, and create a sense of fatigue. 
Although the sensation of tiredness is referred by us to the 
overworked muscles, the location of the cause is less in the 
peripheral than in the central nervous sy.stem. On the one 
hand waste products act upon the muscles, dimini&h their 
contractility and render them less responsive to nerve stimuli ; 
and on the other hand they poison the large nerve cells in the 
grey matter of the brain, render them less receptive of sensory 
stimuli, and in this way reduce their power of emitting 
volitional impulseit. There is, therefore, in fatigue an 
element that is mental as well as physical. After rest and 
sleep the sensation of fatigue wears off, we rise invigorated 
and strengthened for work. During repose structure is 
being rebuilt and waste products are eliminated. The proof 
that the circulation of waste products in the blood is a 
cause of fatigue is demonstrated by taking some of the blood 
of a fatigued animal and injecting it into a healthy one, 
when in the latter the physical signs of fatigue gradually 
appear. Wclchart, in 1904, advanced the theory that the 
cause of fatigtie is a toxin generated in the overtaxed 
organism, and ttiat the ravages of the toxin, like the poison of 



I 

4 



4 

I 




INDUSTRIAL DISEASES AND ACCIDENTS 7 

diphtheria, can be met by the introduction of an antitoxin 
into the body, Wolf-Eissner {Cenirath. /. BakUrioL bd. xl.. 
1906, p. 654) is of the opinion that, during athletic training 
there is produced an immunity to the toxin of fati^c, where* 
by th« trained athlete becomes capable of accomplishing 
more than the untrained man, and without experiencing the 
sensation of fatigue. It is common knowledge that men 
who arc doing hard, physical toil regularly have not the 
sense of tiredness felt by men who are new to the work, and 
we explain this by saying that the latter are not trained. 
Wolf-Eissner throws ne^v light upon the subject. Having 
obtained a fatigue toxin from overworked animals, he 
injected small doses of the poison into other animals and pro- 
duced in them symptoms of fatigue, drowsiness, and a lessen- 
ing of activity. Large doses caused death, but if very minute 
dows were injected for a lengthcrwd period there was 
established in the animals a genuine immunity to fatigue. 
The toxin is not found in the blood but in the muscles, 
whereas the antitoxin is only present in the blood. There 
are certain people whom 1 have already alluded to as neuras- 
thenic who arc languid physically and mentajly, and who 
are so readily tired that they are unable to take up the 
ordinary duties of life We speak of them as being deficient 
in nerve force, but may the explanation not be that their 
condition is one of toxxmia and that they are unable to 
produce the antitoxin of fatigue? 

Men and vroraen who have worked hard and been exposed 
to the weather often look older than they arc, and they give 
evidence of arterio-selerosis or structural changes in their 
blood-vessels. A man's age is largely that of his heart and 
artericsL In men who have wrought hard the circulation of 
waste products in the blood comes in 6mc to tell upon the 
kidneys, heart, and blood-ve$sels. The human body, as 
already indicated, is not without its defences against fatigue, 
and the evil cfTccts upon the heart and kidneys consequent 
opon the long-continued retention of waste products in the 
blood. A. Uossaglia ( Gautt. dtg. OsptdaU t DelU Cliniclu, 
an xxvii., 1906, 2 Sept., No. 105, p. 1 103) has shown that in 
dogs from whom portions of the parathyroid glands have 




8 



DISEASES OF OCCUPATION 



been removed, the production of fatigue is always followe 
by tetanic convulsions and the presence of large quantities of 
albumen in the urine, a circumstance which points to the 
secretion of the parathyroid glands possessing a specific body ' 
which neutralises tlie toxins formed during muscular work. _ 
In the ca^c of several young soldiers after a march out, H 
Sir Thomas Grainger Stewart found a trajcc of albumen in 
the urine, but in healthy subjects muscular exercise is not 
followed by the presence of albumen in the urine, or if so, 
never to any extent. The presence of albuminuria afVer 
physical exercise in dogs whose parathyroids have been 
partially removed indicates that there is a functional relation 
between these glands and the kidneys. The toxins of fatigue 
are capable in course of time of contributing to kidney 
diseases, and in man the thyroid gland when healthy obviates 
this to some extent through the internal secretion which I't^ 
forms. 

As the result of overwork Hodge, an American physt* 
ologist, found structural changes in the nerve cells which 
rest removed. F. H. Scott {^Jaum. Physiology, vol. xxxiv. , 
Nos. I and 2, p. 145) states that in nerve cells there is formed ' 
from the nucleus and Nissl bodies of the cell a substance 
which passes into the nerve fibres. TItese fibres are capable ^ 
of carrying impulses without becoming fatigued, but they f 
cannot maintain the end-organs of the nerve in a condition ' 
of activity beyond a h'mitcd period. It would appear, there- 
fore, as if some substance were given out from the nerve cells, 
hence as a consequence the readier fatigue of the central 
nervous system compared with the peripheral. Scott tried 
to locate the seat of fatigue. Muscle fibre may become 
fatigued, also the nerve cells in the spinal cord, owing to 
the hypothetical substance already alluded to being used 
up and time not given for fresh secretion to have been , 
formed. ■ 

The effects of fatigue, mental and physical, are shown on ™ 
various organs and functions. Intense intellectual effort 
maintained even for a short period Increases the beat of the fl 
heart by s to 20 in the minute with a fall to the normal, or ^ 
even below it, on cessation of work. Mental work, when not 




INDUSTRIAL DISEASES AND ACCIDENTS 9 

too prolonged, gently raises the arterial pressure and the 
temperature, the muscles of the eyeballs become relaxed and 
the pupils dilated and the crystalline lens flattened — pheno* 
mena exactly the inverse of those observed during accx>mmo- 
datton. When the duration of physical work is »hort the 
muscular furce of the hand, as measured by the dynamo- 
meter, is increased, but if prolonged the work done by the 
muscle decreases. The amount of urine increases and there 
is a slight excess of phosphates. The changes brought 
about by muscular work were found by Byesson to be the 
oppowte of tlwse caused by intellectual work. G. Btnet 
showed that in scholastic institutions the amount of bread 
consumed fell with the increased amount of mental work of 
the scholars, and that the body lost weight. One of the im- 
poilant features of overwork calling for notice is the manner 
in which latigiie is repaired. It is a question of length of 
time ; some persons require a longer time than others to re- 
cuperate. It is easier to study muscular fatigue than mental. 
Daring inactivity living muscle is absorbing oxygen from 
the blood and is throwing off small quantities of carbonic 
acid — it is storing up glycogen and fat ; but during activity 
the nutrition of the muscle is quite altered. A larger 
quantity of ox^-gcn is absorbed, the carbonic acid evolved is 
considerable, glycogen disappears, for it is used up, and the 
temperature rises. Tlie contractile substance of the muscular 
fibre becomes acid in reaction, owing to the presence 
of lactic acid and other derivatives. Whenever muscular 
activity is carried to the point of exhaustion, glycogen, 
which is the source of the muscular energy, disappears. It 
b used up, being transformed into carbon dioxide and water 
with lactic acid. Although deprived of glycogen, muscle can 
stilt contract owing to the nitrogenous substances it contains. 
Muscular activity requires nervous activity as well. Nerve 
cells as producers of force, nerve hbres as carriers, and 
inasclcs as the agents of contraction are all involved in 
naoual labour. Ivach of these ptnys its own part in fatigue;. 
The waste materials formed not only induce a sense of fatigue, 
they exercise a paralysing influence upon the nerve endings 
luscle. In animals that died from fatigue H. M. Bernard 




to 



DISEASES OF OCCCJPATiON 



found a mottled condition of the muscles, alteration of the 
nuclei, and under the sarcolemma fine droplets, which were 
apparently dissolution products of myosinc Similarly 
structural changes arc met with in the nerve cells in 
the grey matter of the motor areas of the brain. These 
changes include chromatolysis, irregularity of the outline 
of the nuclei of the cells, and a displacement of the 
nuclei. It would seem that in fatigue there are three factors 
in operation, (i) Accumulationof waste products ; (2) using 
up of the energising substance, muscular and nervous ; and 
(j) structural changes in muscle fibre and nerve cell. The 
using up of the energisinR substance, even to the point of 
exhaustion, is a normal or physiolo^'cal process, but the 
poisoning by dLiassimilation products is more or less patho- 
logical, since it may be followed by definite alterations of 
cell structure. PhysJolc^ical fatigue Is gradually recovered 
from by rest 

When the muscular work is hard and there is consideraUe 
strain as well, there is a rise of blood pressure which is not 
without some influence upon the heart. The heart tn its 
beat has to overcome resistance; if it cannot do this readily 
the organ dilates. Acute dilatation of the heart is one 
of the early physical signs of fatigue, and yet it can be 
prevented to some extent by gradual training. In a man 
who, by d^rees, is trained to bard muscular work, the heart, 
instead of dilating, hypertrophies; it becomes larger and 
stronger and therefore niorc fit for the requirements of the 
circulation. Hence the heading cardiac impulse of the 
labourer's heart and the accentuated second sound heard 
over tlie aortic area. So long as these men are doing hard 
work we cannot regard tlie condition of their heart as patho* 
Ic^cal. What sends the labourer wrong is not so much 
the fact of his having a hypcrtrophied heart or of his doing 
hard work, as alcoholic indulgence and irregular habits 
superadded to muscular strain. In a. large percentage of 
the working men who come under my care in the Royal 
Victoria Infirmary, Newcastle, suflering from heart disease, 
who are broken down in health, the history is generally 
one of exposure to weather, muscular strain, alcoliol and 



I 



INDUSTRIAL DISEASES AND ACCIDENTS ii 



syphilis. In forgemen who are wielding a hc3V)r hammer it ta 
easy to understand that with respiration suspended and the 
diest kept fixed as in expiration, the thoracic and abdominal 
aorta is coinprcsse<l and the right heart and venous system 
distended with blood. 

Physical effort and the lifting and carrying of heavy 
imgfats not only impress themselves upon the muscles and 
nervous system, but upon all parts of the body, particularly 
the bones in early adolescence and the period of growth. 
Hence the stunted growth of the clay-carrying children 
engaged in brickfields, and the deformities of the body and 
spinal curvature met with in persons as the result of standJnj; 
the greater part of the day in a strained poiltion when at 
work. If standing all day when at work in an over-heated 
factory causes tiredness of the muscles and also varicose veins, 
prolonged sitting may be just as harmful, for the lumbar 
region of the spinal column becomes bent, the movements 
of the abdominal viscera are interfered with, the lower ribs 
are compressed, and since deep inspiration is hardly possible 
the lungs are badly ventilated and the aeration of the blood 
is imperfect. 

To protect against excessive fatigue we should encourage 
Rgalar and temperate habits on the part of the workpeople, 
permnal cleanliness, the use of good food, sleeping in wcll- 
vcntilatcd rooms, and the avoidance of over-crowding as far as 
po«sibl& It is difficult, if not impossible, for the poorer work- 
ing classes, Uving as they often do in the slums of large towns, 
to observe and obtain these. If wc cannot control the hygienic 
conditions of the homes of the working classes, wc can at any 
rate insist thai in the factory and workshop the conditions 
under which work is carried on shall be as hcaJthy as possible, 
that means shall be in use tn carry aw.ay duat, tliat the tempera- 
ture and humidity shall not be too hi^h.and that the air shall 
contain e\'cn less carbon dioxide than is allowed by law. If 
employers wish to ha%'c tidy and clean workmen they must 
keep their factory clean. Change of clothing after work- 
ing has a refreshing eflect upon most people, and workmen 
who have washed in the factory and changed their clothing 
rill probably make a better meal on reaching home than the 




Itj diseases of occupation 

unwashed wortcman. The hours of toil should be propor* 
tional to the nature of the work and its fatiguing character. 
Upon young persons the burden of work should be lightly 
imposed, and the individual gradually trained to it. Fatigue 
in the case of pr^nant women should be avoided by not 
allowing them to undertake work of an arduotis nature, 
and by forbidding them going on with their work until 
the end of term.' 

Traumatism, Tuberculosis, and Canctr. Mtdical 
Aspects of tkt Qutstivn 

Since in the wake of an injury there frequently follows local 
\w general disease, the question necessarily arises whether 
' these stand related to each other as cause and ciTcct. A short 
^while ago there came under my care a young woman who, 
'When crossing one of the streets in Newcastle, was knocked 
down by a passing vehicle. Until the day of the accident 
she was a healthy woman and was not knoA-n to have been 
ill ilcr chest was bruised but no ribs were broken. Shortly 
a.{\xx the accident she began to spit btood. From time to 
time she had recurrent haemoptysis. Physical signs of 
pulmonary consumption rapidly developed, and within a year 
the patient died with all the symptoms of tuberculosis ot 
the lungs. The diagnosis was confirmed by post mortem 
examination of tJic body. I was much impressed by the cir- 
cumstances of the case, and could not altogclhcr eliminate 
from my mind the post hot propttr hoc theory that the lung 
disease was the result of the accident Since then 1 have 
seen other cases of injury to the chest wall followed for years 
afterwards by recurrent haemoptysis; thus the question of the 

' After 3 disciiv^on on fatigue at the Inlcmalional Conf^rcss of 
H>-|j:ictic at licTlin, September, 1907, the following rcsolutioa wm 
pftsaed : Since th« capability for wotk rariesi not only indiTidualljr 
according 10 the coasUlution, age, sex, and mode of life, but also in tbe 
same individual al different periods of life, a permanent skilled control 
matt be k«pt in all uuuiiul ur inlvllecluiil industries, ioduding tnisincsa 
occupalioDS, and also occupations to which workmen are opu^d to 
special dangers ; this should be carried out in &uch u way that x prop«r 
aUowancc would be made fof the individual CA^ubility fut work. 




i 



INDUSTRIAL DISEASES AND ACCIDENTS 13 

posnbility of a causal connection between injury and tuber- 
culous lung disease is one to which an answer must be 
returned, and especially so in vteiv of the Workmen's 
Compensation Act 

The sequence of trauma and tubcrcula<ris has hitherto not 
attracted much attention in tins country, either because of 
the infrcqucncy of the occurrence, or because medical men 
with their knowledge of the bacillary cause of tubercle have 
not thought it necessary to inquire into the possibility of 
such a relationship. On the Continent, where compensation 
for injuries received at work has been carried further in some 
respects than in Britain, the subject has been frequently 
torccd upon medical men for their opinion, and what has 
occurred in European countries will shortly take place in our 
own. Medical men will be obliged to have an answer ready 
to the question, Can an injury be the determining cause of 
tuberculosis, or is it that injury simply lights up a tuberculous 
lesion until then latent and possibly on its way to spon- 
taneous cure ? If an accident received at work is the cause of 
tuberculous disease of a subjacent oi^an, which disease but 
for the accident v«)uld not have arisen, the claims for com- 
pensation advanced by the injured person, or his relatives, arc 
not without a reasonable foundation. The difficulty »-ill always 
be that in most of the cases there is no proof of the healthy 
coodition of the body previous to the accident, a difhculty not 
lessened but rather increased by the fact that in about 70 
per cenL of the bodies of persons dying from all causes there 
are evidences of healed localised tuberculosis of the lun^rs. 
At the Morgue tn Paris Prufcs:ior Brouardel found old tuber- 
culous lesions in one half of the bodies of persons above 
30 years of age; and Letulle, at the Ilopital St Antoine, 
I'sris, in 131 autopsies in cases of violent death, found 
evidence of pulmonary phthisis in 25. We all know how 
tuberculous gland disease can exist for years without 
giving rise to symptoms. The disease remains latent until, 
perchance, the glands become in^ained or they soften and 
mpturc and allow the imprisoned tubercle bacilli to escape. 
A man or woman receives a blow on the chest has a ha:m- 
otrhagc or not, as the case may be, and be dies months 




DISEASES OF OCCUPATION 



afterwards from pulmonary phthisis; or he meets with 
accident when at work, the injury is regarded and treat 
as a sprain, but it is followed by a " white swelling" of 
joint, which is tutierculous. What is the association 
Medical opinion is divided. There arc many surgeons who 
believe that tuberculous disease of the joints and bones may 
be; the consequence of an injury, but when we consider how 
many shocks and blows persons, young and okl.afC receiving 
and how infrequently in comparison "white swelling" of the 
joints appears afterwards, the association of trauma an 
tuberculosis cannot be so very close and frequent, othcrwi 
we would have seen and heard more of it than we have. | 
is an interesting fact that in these cases where patients ha' 
given a history of injury there has been in nearly e 
instance no fracture of the subjacent bone and no tearing, but 
only bruising, of the skin, yet of i 59 individuals who received 
penetrating wounds of the chest-wall Dcmmc found that 
1^ died some time afterwards from pulmonary phthisis. 
One of the first to draw the attention of the profession to this 
subject was Professor Teissier, of Lyons {Lyons M^dicah, 1 873, 
p. 10). A male patient, a baker, aged 30, who bad never 
an illness, and who was in perfect health at the time, receive' 
a blow un his right chest and shoulder by a falling beam. 
So violent was the blow chat the patient was rendered 
unconscious. None of the ribs were broken nor was 
shoulder-joint dislocated, but there was swelling witli redm 
of the right shoulder-joint immediately after the accid 
the man brought up a large quantity of blood by the mouth, 
and for eighteen months afterwards hxmoptysis was frequent 
Three years after the accident Professor Teissier, finding 
man in advanced phthisis, concluded that the pulmonary 
consumption was the result of the accident and K^cmorrhage. 
About the same date a shoemaker, believed to be in perft 
health, was struck in the chest by the pole of a carriagi 
This man had immediately afterwards a severe h^moptysis^ 
which continued off and on for several days and then 
remitted, but the patient succumbed later on to phthisis. 
Teissier published his cases before the discovery of the 
tubercle bacillus by Koch. He was of the opinion that 





INDUSTRIAL DISEASES AND ACCIDENTS 15 



mjary wras capable of causing, through the blood that 
escapes, a bronchial irritation which ultimately leads to 
pulmonar)' phthisis in persons predisposed to the malady. 
It was therefore a. phthisis ah hittnopt^x. In 1S75 Perroud 
drew attention to the frequency of phthisis among the sailors 
on the Rhone. These men arc of good physique and they 
fellow a healthy occupation in the open air. The disease was 
attributed to the nnen leaning with tlicir chest wall upon the 
pole of the rudder in steering their ships. It was tbought 
that the repeated pressure favoured the development of 
pulmonary lesions, the interesting point being that the 
maximum focus of the disease as revealed by auscultation 
always appeared to be located at the level of the point of 
prcssurcby the pole, viz., under the right clavicle. Thcsailors 
themselves were of the opinion that their illness was the 
result of leaning on the pole. 

In 1SS4 Germany decided to compensate workmen for 
accidents received .it work. At first it was principally "white 
joints " coming on after injury that furnished tlie objects for 
consideration. Honscll {lieair. Klin. Chir., 1900^ tome xxviii. 
p. 659) investigated 1,729 cases of so-called articular rheuma- 
tism. He found in 242, or 14 per cent., a traumatic origin. 
In 577 cases of tuberculous disease of bones and joints under 
the care of Rostock between 1890-1902 Voss obtained a 
history of traumatism in 12; : 88 per cent of the patients 
were between 30 and 40 years of age, and 4 per cent, between 
JO and 60. In nearly every instance the accident was a 
luxation or contusion, in only one instance was there a 
fracture. Voss concluded that in one-third of the cases the 
lesion was not of traumatic origin, in one-third the influence 
of traumatLsm wa.« doubtful, while in one-third injury had 
played a part When a white swelling of a joint has developed 
a patient naturally tries to account for it, and he is tempted 
lo recall to memory some injury, severe or slight, to explain 
the occurrence of his malady. 

There have been, comparatively speaking, few literary con- 
tributions to the subject of traumatism and tuberculosis in 
British medical pcri'jdicals. One of the most interesting is 
(lom the pen of Dr. James Weir, of Glasgow {Brit. Med. 



16 



DISEASES OF OCCUPATION 



Journal^ May 33, 1903, p. 1 196). He reports the case or 
man not altogelbcr free frotn a tuberculous family history 
who had had pneumonia in the left lung more than twenty 
years previously, and who received a severe blow over the 
lower part of the right chest and mid-axiliary region when 
at work. He was treated at the time for a bruised side^fl 
Two weeks afterwards he was found (o be suffering from^ 
what appeared to be pleurisy. Two months later there 
were cough with cxpcctoratipn, hxmoptysis, signs of con- 
solidation at the right apex, and considerable emaciation. 
The sputum on being examined was found to contain tubercle 
bacilli Under treatment by creasote, cod-liver oil, &c., 
patient improved considerably in strength and weight, he 
lost his cough, tubercle bacilli disappeared from the expec- 
toration, and the right apex became clear and free from 
riles. In Dr. Weir's patient the part of the lung that 
became affected corresponded with the injury to the chest 
wait, and as the man had been apparently quite well at the 
time of the injury, an opinion was expressed in favour of 
some connection between the two events. The effects of the 
bruising had penetrated the wall of the chest, had reached 
the pleura, and after affecting it had cither set up patholt^ical 
changes in the substance of the lung itself or weakened it 
functionally. A focus of tubercle in the lung substance Just 
underneath the pleura i-s apt to set up a limited patch of dry 
pleurisy ; but may not pleurisy as a primary lesion, such as 
that caused by an injury, so impair the function of the under- 
lying lung as to render it a suitable nidus for the develop- 
ment of tubercle bacilli P Experience shows that it is in 
those portions of the lungs that move least in respiration and 
are therefore the least well ventilated, viz., the apices, that 
tubercle bacilli are most prone to develop. The effect of 
plcuri.sy upon subjacent lung is to impair its movements; the 
lung neither expands nor contracts so well, morbid secretions 
are retained in the small bronchi, stagnation occurs, and the 
vitality of the lung tissue is reduced. These arc clinical facts, 
but an appeal may be made to exiwrimcnt. Von Krause, in 
1890, inoculated guinea-pigs under the skin, and rabbits in 
the pleura and peritoneum, with pure cultures of Koch's 



INDUSTRIAL DISEASES AND ACCIDENTS 17 

hodllas. He subsequently caased contusion and sprains of 
their }otnU, and in a few instances fracture of the bones and 
dislocation of the joints. Three to seven weeks after the 
injarics scvera) of the animals died from miliary tuberculosis. 
Some of the animals that had received bruises presented the 
lesions of joint tuberculosis, vir., 34 per cent, of the guinea-pigs 
and JO per cent of the rabbits. There were also evidences 
of tuberculous disease of the lungs, tn other expenmetits, 
carried out by Lanndonguc and Achard although the 
animals died from tuberculosis, there were no tuberculous 
iMlons in the lungs, but in their experiments the injuries 
were not inflicted until nineteen to twenty-one days after the 
inoculation, too late to determine the relation of tubercle and 
injury. Petrow {Central. BLf. Chir., November 26, 1904) in- 
jected tubercle bacilli into the peritoneal cavity of twenty-six 
guinea.pigs. All of them died of tuberculosis. In fourteen of 
them tberc were, on histological examination of the epiphyses 
of the joints, evidences of tubercle, and yet during life there 
had been no signs present to betray its existence. In other 
words, a latent tuberculous arthritis had been established. 
In another set of experiments Fetrow injected tubercle bacilli 
into healthy joints, and also into other joints previously 
subjected to traumatism. On a subsequent examination of 
the joints of animals that had not been previously injured, 
the tuberculous lesions remained limited to the ligaments 
and the capsules round the joints, but in the traumatic joints 
the lesion invaded the cartilages and the bones. These 
experiments show bow aggravated become the symptoms 
and how extensive the tuberculous lesions when the joint 
has been injured as well. Whatever our views individually 
may be upon tJiis subject, wc cannot but admit that injuries 
play an important part in lighting up pre-existing microbic 
zl)i»nions. Tuberculous lesions of lungs and joints may be 
latent and for a time unattended by symptoms until an injury, 
perhaps, is received, when a tuberculous lesion that was 
dormant becomes active. 

It is a question whether the subject under discussion can be 
Mtted by experiment alone, since in animals tubercle bacilli 
Ire usually injected in larger quantity than occurs in man. 



i8 



DISEASES OF OCCUPATION 



i 



In thenk the blood is flooded with the micro-organ ism, but' 
in min the invsision is slow, and the injuries are not always 
comparable with those experimentally produced in animals. 
In the development of tuberculosis after an injury there are 
two point* to be borne in mind: (l) at the time of the 
accident Koch's bacillus may have been already present ini 
the body of the injured person, cither in the part struc)c.| 
or at some distance from it : and (2) the injury received ' 
increases in some way or other the vinilence of the bacilii. 
The rdlc pla>'cd by injury may be simply that of an 
accessory. Had the accident not occurred at the particular 
time, tuberculosis might probably have developed all the 
same, but from the Workmen's Compensation point of view, 
since the injury roused into acUvity what ultimately became 
a fatal disease, a claim for partial compensation under these 
circumstances is not altogether unreasonable. 

Dr. ^losny, of L'Hopital Su Antoinc, Paris, is of the 
opinion that an accident determines in a general way the 
development of a localised tuberculosis at the point struck, 
only when the malady already existed there in a latent 
form. It requires, according to him, a local congestion of 
the blood vessels to light up the malady, hence an injury, by 
creating an inflammatory condition, is thus able to light up 
disease till then latent. A contusion acts in a similar 
manner. It is not necessary to have the skin broken in order 
that deeper seated tuberculosis shall thereafter develop. An 
injury may unmask a latent tuberculosis, or it may aggravate 
an existing tuberculosis in a patient who in already phthisical 
and hurry on the disease to a fatal termination. Taking 
this view of the matter the injury would only reveal a morbid 
state which was there before, but was not causing symptoms, 
so that when a person receives an injury to his chest and 
shortly al^rwards has a spitting of blood, the hxmoptysb 
would be simply a sign of tuberculous lesion of the lung 
already in existence, the vascular equilibrium of which had 
become broken by the injury. But there are several cases 
of recurrent bxmoptysis after injury that have corac under ^ 
my own observation, where 1 am convinced the lungs wcxe H 
hi^thy before the accident, for since the injury, beyond a 



4 



IJfDUSTRlAL DISEASES AND ACCIDENTS i<; 

facmrent haemoptysis once a year or once in two years, the 
nost careful examination of the lungs has failed to reveal 
the existence of tuberculous disease of the lungs. But this 
is in people whose family history and whose previous health 
were good. What might have happened in persons pr^ 
dispo«ed to phthisis it 15 impossible to say. In all probability 
tabcrcolosis would have supervened. An injury to the chest 
wail is sometimes followed by a limited inflammation of the 
lung of an indefinite type, which is slow to disappear. A 
lesion thus created becomes a Rt soil for the reception and 
multiplication of micro-organisms of various tcind.s, including 
the tubercle bacillus. It is convenient in these cases to fall 
back upon a pre-existing localised tuberculosis, but this is 
only assumed, for there is no proof of such before the injury. 
Sudden and profuse haemoptysis coming on shortly after an 
accident cannot in every instance be due to an already 'exist- 
ing tuberculosis of the lungs. The vascular conditions upon 
which the bleeding depends may be, therefore, a direct con- 
sequence of the injury through the intermediation of the 
nervous system, so that if the tubercle bacillus which lives, as 
some pathologists maintain, as a saprophyte in the upper 
respiratory passages is not kept in check by the phagocytes 
of the lungs and bronchial mucous membrane, the tubercle 
bacillus might become grafted on to the pulmonary lesion, 
a drcumstance likely to occur if the patient at the time is 
run down in health and is living under unhealthy or depres- 
sing conditions. The injury would prepare the way for 
in&ection by tubercle. Dr. Marix, of the Prussian army, 
gives the statistics of 79 cases of soldiers injured in the chest. 
In 21 of them there subsequently developed tuberculosis. 
The raicro-organism was found in the expectoration of 7 of 
the patients 3 months after the accident, in 8 of the soldiers 
from 3 to 11 months after, in 5 after 13 months, and in i 
after 7 months. In 2 of these 2 1 soldiers there w.is a family 
history of phthisis. Seven of the soldiers were received into 
the hospital immediately after the injury. There is no 
definite date at which tuberculositi develops after an accident 
to the chest wall Tubercle bacilli have been found in the 
sputum as early as one month after an Injury. 



ao 



DISEASES OF OCCUPATION 



A subject duch as we have been discussing would be In 
complete did wc not take into consideration the relationship of 
profuse " blood spitting " after severe muscular strain. wJthoi 
external injury and pulmonary phthisis, One illustration 
several will suffice. I have recently seen, in consultation with 
Dr. Dinsmore, of Backworth. a colliery engine winder, ^jed 
forty-seven, suffering from recurrent bleedings from the lungs,; 
attended by the physical signs of consumption. Twclv 
years aj;o, when a typically healthy man and free from an 
family tendency to tuberculosis, he lifted a heavy iron man- 
hole door. He was conscious that he had overstrained himself, 
but he paid little attention to the feelingoffaintness and sick* 
ness at the tlnne. On the following forenoon when at work 
be was suddenly seised with profuse bleeding from the lung. 
He went home, stayed in bed, and in a week or ten days was 
well again. For five years he kept, on the whole, well, when 
he had another spitting of blood. Since then he has had 
recurrent bleedings every few months or weeks, which have so 
enfeebled him that he can no longer follow his employment. 
In the chest tliere are tlie physical sigiis of phthisis. The 
phthisis in this patient is as much the consequence of the 
traumatic hemoptysis as if, instead of coming on years afler 
the accident or strain, it bad developed immediately after- 
wards. The fact that the blood spitting did not show itself 
until the tUiy after the strain does not militate against the 
relationship between the two. My experience of this in other 
patients is that the tucmorrh^c usually occurs on the 
second day after the strain and not immediately after it 

It is the circumstance of the small number of cases of 
tuberculosis following accidents, not more than 5 per 1,000, 
that diminishes the value of the relationsliip. A closer 
intimacy, on the whole, exists between injury and tubercu- 
lous disease of the joints and bones, than between injury 
and disease of the lungs. White some surgeons give the 
percentages as varying from 8 to 40, the average is 12 
to 14. This is higher than our experience in Newcastle. 
The medico-legal aspect of this question cannot be ignored. 
Some of my readers will be called upon to express an 
opinion when a claim has been raised as to whether (l) the 



of H 

off! 

:h 

id 



* 
4 




INDUSTRIAL DISEASES AND ACCIDENTS at 



accident lit up a tuberculosis that was latent or was possibly 
on the road to cure ; (2) accelerated a tuberculoHis that 
waa in process of evolution ; or (3) prepared the tissues for 
tbe reception of the tubercle bacillus. If it can be shown 
that but for the accident a man would have remained In 
good health and been able to follow hts employment the 
claim for compensation will have to be carefully considered. 
This will necessitate an inquiry into the persona! and family 
history of the injured workman and medicnl affirmation as to 
the absence of previous pulmonary disease. It is cxtrcniely 
ttearablc, too, that a stcthoscopic examination of the patient's 
chest should be made soon after the accident, and such con- 
ditions noted, for example, as the location of physical signs 
in the lung compared with the site of injury to the chest wall, 
not chat the disease invariably develops at the same spot. In 
Germany the question of com[x:nsation does not arise in this 
manner, for sictc workmen arc paid out of sick, accident, 
or old age funds that arc managed by the State. In Great 
Britain the trend of legislation is in the German direction. 

As after an injury to the chest wall pneumonia has occa- 
sionally superveT>cd, the question is sure to be raised as to 
whether there is any causal connection between the two. 
Pneumonia is as much a microbic disease as is tuberculosis, 
but tt is more definite both as regards its invasion and period 
of incubation. In several instances, varyir^ from fourhours to 
(bur days, pneumonia has developed after a contusion of the 
chest wall. In some patients the disease has not developed 
until the sixth day after the accident, and in one case not 
till the fifteenth, but even in these patients there were 
previously cough, sanguinolent sputa, and pains in the 
chest on deep inspiration, all suggesting that the disease 
had existed for several days before the patient had been 
iten by the doctor. Part of the pain complained of is 
probably the result of the injury to the side and not of 
the concurrent pleurisy as in ordinary cases. In deal- 
ing with this subject of the relation of traumatism to 
pneumonia, it must be borne in mind that a patient might 
go on working for a few hours after or just at the 
time a pneumonia was developing, or had only begun to 



DISEASES OF OCCUPATION 



m.inifest il««If, so that an injury received then could not be 
tlie cause of a malady that was clearly antecedent to or con- 
current with a supposed injury. A patient may go about 
with an " ambtilatory " pneumonia for a few days and die 
rather suddenly from it, when a lobe of the lung is found to 
be in a stage of red hepati ration. All these facts have to 
be borne in mind when the subject of contusion pneumonia 
is under consideration. One prominent symptom is that in 
traumatic pneumonia there is generally a history of harmop- 
lysis shortly after the accident. The micro-organism of 
pneumonia is normally present in the mouth and buccal 
secretions of healthy persons. When, therefore, a man has 
met with an accident to his chest wall and ha:moptysis has 
occurred, the diplococcus which until then had been leading 
a saprophytic existence in the mouth probably finds in the 
aanguinolcnt expectoration and in the lung tissue altered by 
the haemorrhi^e a medium Civourable to its development 
Probably my estimate is above the mark when I say that in 
not 1 per cent, of the cases of pneumonia is there a history 
of an accident, and yet I have known of cases where the one 
has followed the other. As far back as 1896 Professor Jacoud 
reported to the Academy of Medicine, Paris, the case of 
a man who had received a blow on the chest which was 
followed by haemoptysis. A few days afterwards there super- 
vened pneumonia, which was at the time regarded as the result 
of the injury. Five months afterwards tubercle baciUi were 
found in tJie sputum and a cavity was detected at the .lite of 
the previous pneumonia. As tubercle bacilli were absent 
during the pneumonia Jacoud was of the opinion that the 
localised pulmonary inHammation had, by reducing the 
vitality of the lung, paved the way for the entrance of 
the tubercle bacillus. 

Contusion or traumatic pneumonia in no way differs, either . 
as regards its clinical features or bacteriology, from ordinary^f 
croupous pneumonia, except that tlie expectoration contains^ 
more blood and there is a history of ha:moptysis. Although 
the physical signs of the pulmonary disease, r^., dulness on 
percussion, crepitant and other rSles. u.<}ually appear at the 
site of the injury, this b not necessarily the case. I'rcqucntly 




INDUSTRIAL DISEASES AND ACCIDENTS 23 



I 
I 



is nothing to be detected extem&lly on the side that 
'was said to have been injured. 

In cases where pneumonia and tuberculous diseases have 
appeared after accidents and the malady has led to a fatal 
termination, no opinion as to th« relation of the accident and 
the disease should be expressed in a court of law without a 
post-mortem examination having been made Acute pleurisy 
with effusion, for example, may develop any time from two to 
six weeks after an injury to the chest wall, and while in the 
Suid remored by aspiration from the chest for diagnostic 
purposes no micro-organisms may be found, yet on injecting 
some of the fluid into guinea-pigs tuberculosis may develop, 
and at the autopsy of the injured workman evidence may 
be found of old tuberculous disease in the apices of the 
lungs. The pleurisy in such a case would be tuberculous 
and due to pre-existing pulmonary disease. In a similar 
manner tuberculous meningitis in children and also in adults 
oceasionally develops after an injury to the head, yet in 
nearly all the fataJ cases there have been found at the 
autopsy either caseous glands or recent or old tuberculous 
lesions in the lungs. 

Blows upon the abdomen and strains and injuries to the 
tieclc seem, according to Rolleston <" Altbutt's System of 
Medicine," vol. iv. p. 54.2), to have been the cause of 
Addison's disease, either by the injury impairing the vital 
resistance of the suprarenal glands as to render them more 
vulnerable to the tubercle bacillus, or by giving rise to 
haemorrhages in them. Since traumatism can cause inflam- 
mation of serous and synovial membranes such as those of 
the pleura and joints, there is no reason why it may not also 
cause peritonitis. Injury docs not appear to be often, if at all, 
directly productive of appendicitis in previously healthy 
pCTsoiis. The cause of appendicitis is more probably ab intra, 
but injury of the abdomen might readily reveal a latent 
appendicitis or give rise to a hnsmorrhage into the appendix. 
Traumatism, shock, and exaggerated muscular effort are more 
;1ikely to re-light an appendicitis that had died down and had 
1>CCome cured without operation. Where this occurs and an 
tion has to be performed, is the injury to be regarded as 



DISEASES OF OCCUPATION 



the cause of the malady, and is the individual therefore to be 
compensated f There is Uttle doubt that the extension of the 
Workmen's Compensation Act will tend to bring within the 
category of injury many illnesses that lia%-e hitherto been 
considered in no way directly associated with traumatism. 
The importance of this remark is at once apparent in such a 
case ait the following. A man who is Icnown to indulfp; too 
freely in alcohol receives an injury. The injury of itself is so 
slight that under ordinary healthy circumstances recovery 
would be rapid and complete, but owing to the man's habits 
delirium tremens develops, and in the course of this the 
patient dies. But for the accident there would have been no 
delirium tremens ; to that extent, therefore, the injury has 
determined the malady, but had there been no excessive 
indulgence in alcohol there would have been no delirium 
tremens. What view will British lawyers take of such an 
association of circumstances? The I'Vcnch Act of 1898, 
rccc^nising that traumatism had played even a small part in 
the development of symptoms, would indemnify the relatives. 
The relation of malignant disease and injury is frequently 
raised in mcdico-l^al inquiries. That cancerous and sarco- 
matous tumours develop after an accident, close to ^^H 
site of the injury, and that the one is the direct sequence of^ 
the other, there is not the least doubt How the tumour 
comes we do not always know. A man receives an injury to 
the right side of his chest and dies ten months afterwards ^ 
from malignant disease of the liver ; another man falls on his^ 
head in a shipyard, and a year or two afterwards dies from a 
sarcomatous growth in the brain. In some cases the connec- 
tion is clear enough and the claim for compensation can be 
honestly maintained, but it is absolutely necessary, in all 
such cases leading to a fatal termination, that a post-mortem 
examination should be made in order to ascertain whether 
what is apparent on the surface of the body is the primary or 
secondary growth. Only recently my opinion was asked in 
the case of a man with a malignant growth in the glands of 
the right side of the neck, who stated that when carrying a 
plank two months previously he had slipped and had thus 
injured his neck. A medical man who saw him two or three 



INDUSTRIAL DISEASES AND ACCIDENTS 25 



days after the acddent certified that the patient had ruptured 
Mine of the muscular 6bres above the clavicle, and. as a 
cniuequencc, the employers paid him his wages. When I 
saw the patient, in addition to the large mass of glands in 
the ncckf there was loud, stridulous breathing, which the 
glands in the neck, from their situation, could not explain, 
and on careful conversation with the wife of the injured 
man i learned that on the evening of the accident she had 
delected a nodular swelling in the neck. At the autopsy, 
two other medical men and myself found, as was expected, 
that the glandular mass above the clavicle was but an 
extension upwards of a much larger growth inside 
the chest which had encircled the trachea and was the 
priiiiaxy scat of the disease. The necessity of a post-mortem 
exsuttination in all cases where malignant disease is said to 
have followed an injury must be insisted upon. It is 
(mpossjhie to discuss at length all the diseases, especially 
those of the iicr\'ous system, that may develop after injuries. 
Diabetes insipidus may be a direct consequence of a fall upon 
the back of Ute head ; there arc numerous forms of traumatic 
neuritis and a host of neuroses, all of which must be dealt 
with on their own mcriLi. Nor can the subject of hernia and 
its relation to strain and injury be dealt with here. Common- 
sense and experience must guide a medical man in coming 
to an opinion upon these points. Rupture of the diaphragm 
IbUowed by hernia of the stomach into the left pleural cavity 
is A serious condition occasionally met with in railway servants 
who have been crushed between the buffers of wagons, and 
in whom the diaf^nosis would be made by the displacement 
of the heart to the right, the presence of tympanitic resonance 
in the left chest, haimoptysis and physical signs of ha:mo- 
pneumothorax if the lung has been torn, coflec-ground 
vomiting and a diminution in the circumference of the 
abdomen. Pain is complained of over the prccordium and 
in the dorso-lumbar region of the spine. Severe as the 
accident is, many of the injured apparently suffer very little 
at first, but serious symptoms soon show themselves. In an 
accident such as this, if the patient's condition permitted of 
X-ray photograph would be of considerable assistance 



26 



DISEASES OF OCCUPATION 



tn making a diagnosis. It must always be borne tn mind 
that a severe injury to the chest or abdomen may cause 
rupture not only of healthy organs, t^., spleen or kidney, 
but may induce rupture of a latent thoracic aneurism or a 
hydronephrosis, and thus lead to death. A fatal termination 
under these circumstances would be none the less the result 
of accident, notwithstanding the previous existence of serious 
disease. 

There arc certain trades in which cancer occurs with 
greater frequency than others. As the subject is dealt with 
in other parts of this book, allusion need only be made here 
to chimney-sweeps' cancer and the occurrence of malignant 
warts on the forearms of coal, grease, and jiaraffin work 
Dr. John Clay has recently drawn my attention to 
presence of a malignant wart on the back of the hand of 
bacon-curer. This is an unusual situation for a malignant 
wart It is therefore probably more than a coincidence. 



lani 
>f a 



Simuiaiion of Disease in view of Compensatton 
In countries wherein conscription imposes upon the able- 
bodied male population the burden of carrying arms, it is 
easy to understand that all kinds of deception will be tried 
in order to evade this national obligation, and in countries 
in which workmen receive compensation for injuries and 
diseases of occupation there is freciuent resort to fraudulent 
methods to obtain money. In Germany and Switzerland, 
where compensation has been extended to workmen for 
several years, it is known that the workmen have ukcn ful^J 
advantage of the Act, and that in many instances they ad^| 
accused of having made convalescence as protracted as 
possible. It is only recently in France that the bcnctits 
have been extended to the working classes, but already in 
France there has grown up a special literature dealing with 
malingering. 

Many of the monographs written upon the subject expose 
a state of things that doe;) not bid for amity between 
employer and employed. There is. perhaps, too great a 
tendency on the part of the public to make a comparison 




INDUSTRIAL niSEASES AND ACCIDENTS ty 

between an injured workman who is generally poor and an 
employer who is believed to be wealthy, and as a consequence 
the sympathy of the working dasscs and of a lat^e section 
of the public goes with the injured workman. By this 
expccsaton of sympathy and wide support the simulation of 
di^iase is rather fastered than otherwise. The problem of 
simulation has a double aspect, it is not only a question 
of « workman who has been injured pretending to be the 
sobjeet of a disease from which he Js quite free, it is also 
one of a workman, for exampk: a lead worker, continuing 
to rollow his employment and concealing his symptoms so 
as to cam his living ; or. in view of the extension of the 
Workmen's Compensation Act. a sailor known to tw the 
subject of heart disease or aneurism trying to pass himself 
off as a healthy man and dt for work. How often loo do men 
and women of the middle class, also those of good society, 
pietcnd to be the victims of serious injuries after even 
mild railway accidents I There is a nervous condition left 
after the shock which partly explains this. Self-inflicted 
wounds:, too, and mutilations are not unknown in the arena 
of forensic medicine. In Britain there is not, so far as I 
know, any law which inflicts punishment upon men and 
women for simulating disease for fraudulent purposes, but 
In France, Prussia, and Austria the law can deal with such. 
Both mental and physical ailments can be simulated. 
Epilepsy, true or false, and attributed to industrial con- 
ditions, is not al^vays easy of differentiation. There is no 
ONE symptom by which mock or simulated epilepsy can be 
recognised. The f<mt emtmhle must be considered. It is 
always difficult to appraise at their proper value s)-mptoms 
that arc purely subjective. Headache is just such a symp- 
tom. A man who ha« received an injury to his head may for 
months afterwards complain of headache which unfits him 
for work. There arc frequently no physical signs by means 
of which the statement can be corroborated or disproved, for 
it is purely a sensation on the part of the patient It is 
no'er wise to totally disregard the complaint of a patient, 
lor aAer severe injury to the head there may develop a 
limited meningitis or possibly a tumour, either of which 




38 



DISEASES OF OCCUPATION 



may be causally related to the injury. On ophthalmoscopic 
examination the detection of neuro-retinitis wouW be of 
considerable assistance !n guiding the medical examiner to an 
affirmative opinion in regard to an organic cause for the bead- 
ache, but the ab<ience of retinal changes would not necessarily 
point to the headache as having no existence except in the 
imagination of the patient The urine in such cases ought 
to be examined for albunten, and the possibility of uncmta 
excluded. In the consideration of a paralysis complained of 
by persons who have recei\"ed injuries, the co-existence of 
extensive anaesthesia along with the loss of muscular povrer 
would suggest a hysterical or inhibitory cause, and not an 
oi^anic lesion, provided, of course, that such an accident had 
not happened as the division of a nerve. None the less, too, 
the hysterical condition observed in a patient might be just 
as much the result of an accident and nervous shock as a 
cerebral lesion itself, and a similar remark applies to the 
complaint of loss of sight in one-half of the eye and to loss of 
speech. To be the consequence of a structural lesion there 
would have to be additional signs, and these arc absent in 
hysteria and neurosis. 

It is more difficult to set a proper value upon paresis, or 
incomplete \<xa of muscular power, owing to its subjective 
character, than upon paralysis. Simulated paralysis like 
tliat due to hysteria frecjucntly disapjwars and reappears — i 
comes and goes. It is characteristic of tlie hysterical paia.- 
lysLs that comes on after an injury that the symptoms do not 
correspond with anatomical and physioi<^icaI facts; During 
the stage of excitement that occurs when an anaesthetic is 
bdng administered to any one who is the subject of trau- 
matic hysteria the paralysed limb is often lifted and moved 
quite well by the patient. 

Spasm and contraction of limbs frequently occur after 
fractures as the result of the broken bones having been too 
long in splints. The joints feel as if fixed and tightened. 
Under an anxsthetic the contracture, if it is organic, remain 
In hysterical spasm of the hand, for example, where 
fingers are drawn forcibly towards the palm, these can 
lifted up by the medical examiner, who wilt feel the si 



% 



4 

-% 



INDUSTRIAL DISEASES AND ACCIDENTS 29 



lors of the muscles gradually give way ; but ir the spasm 
is simulated, i>., is voluntary, and is kept up by will, the 
individual cannot help ina.king muscular contractions, and 
these are irregular and are felt. 

Occosioitally symptoms of a severe and tasting character 
develop after an injury. A man or woman after an accident 
becomes, for example, paralysed in the left arm and leg, also 
ID the leR side of the face, although in the circumstances of 
which I spcalc the face is usually unaffected. It is extremely 
difficult at first to say whether the loss of power on the one 
side of the body is functional or the result of an organic 
cause. The absence of heart and kidney disease and of a 
htstor>' of syphilis, also the normal appearance of the optic 
disc and retina in a person who has received an injury, and 
in whom the symptoins came on a few days after the accident, 
suggeiit A functional origin for the disease, a diagnosis which 
is strengthened should the loss of power be more pronounced 
in the leg than in the arm and be accompanied by loss of 
seitsation, i>., aniir-slhesia and analgesia in the afTected limbs. 
In hemiplegia, consequent upon a block or rupture of a cerebral 
Uood'vessel, hemianesthesia seldom accompanies hemiplegia. 
When, therefore, in addition to hemiplegia there is anarjthesia, 
which involves the left half of the tongue and buccal mucous 
membrane as well as the limbs, and is attended by defective 
sight and hearing or by continuation of the loss of sensation, 
while the motor power of the limbs is improving, the func- 
tional nature of the illness is almost assured, even if there is 
distinct evidence of a certain amount of facial paralysis 
present at the same time, A ha;morrhagc into the posterior 
part of the internal capsule might involve both motor and 
sensory fibres, so that hemianxsihesia could quite well 
accompany hemiplegia. It would be necessary, therefore, 
to make a careful study of the field of vision, since in func- 
tional cases incomplete loss of sight is often complained of. 
A lesion of the right internal capsule which interferes with 
sight produces a left homonymous hemianopsia. The visual 
defect would involve half the field, or be hemiopic and not 
concentric. C. O. Hawthorne (" Functional Hemiplegia," 
Clinifoi Jtwmal, Dec. iz, igo6) maintains that "defective 




30 



DISEASES OF OCCUPATION 



acuity (amblyopia) and a contracted field when 
with and on the same side as a hemipl^a ( 
fore 'opposite' or 'crossed' in reference to the site of the 
presumed cerebral disturbance) arc in the highest d^roe 
su^estive of a functional explanation of the paralysis." To 
the above add dislocation of the natural order of the colour 
fields, the circles of which arc nominally from without inwardi 
blue, red, and green, and the functional nature of the malady 
is confirmed. 

Pain in the back and npinal tenderness elicited on pnes*' 
sure, arc often hysterical ; so, tcx>, may be a lateral deviation 
of the spinal column, which examination under an anxsthetic 
dears up. On the other hand, pain in the lumbar region of 
the spinal column may undoubtedly be the result of severe 
strain caused by lifting a heavy weight, and be due to rupture 
of muscular fibres or stretching of spinal ligaments followed 
by effusion around nerve fibres. Spinal caries may even be 
the result of such a strain, and of this in its earliest stages 
pain may be the only symptom. As regards Pott's disease, 
injury may be directly or indirectly a cause 

Diabetes insipidus not infrequently follows injury to the 
back of the head. I have known it occur in men who, when 
at work, had fallen, and in their descent had knocked the 
head against a beam of wood or piece of iron. A few 
days aAeiwards. when consciousness had been regained, some 
of the men asked for water to drink, and exhibited a 
thirst difficult to satisfy. The polydypsia has invari. 
been followed by polyuria, which persists^ and diabe' 
insipidus is the consequence. This illness, of which the 
outward sign is the elimination of several pints — lo to 20 
—of pale urine in the twenty-four hours, might \vell be 
simulated by men drinking large quantities of water. 
Under such circumstances the patient would have to be 
kept under observation for a time and carefully watchi 
One sign in particular would help to a diagnosis 
traumatic diabetes insipidus, and that is the presence 
structural changes in the optic disc in the directi' 
of atrophy, net necessarily accompanied by marked loss of 
vision. The need of keeping also under strict 



f I 



:d a ' 
abM 



be 
ia^^ 



J 



INDUSTRIAL DISEASES AND ACCIDENTS 31 



a patient who b said to be suffering from diabetes ntellitus, 
the supposed result of an accident, is apparent, since people 
have been known to add sugar to their urine so as to simulate 
diabctfS. 

Hjemoptysis, or blood- spitting, is frequently simulated. 

LU manner of deception is practised to ffain a particular 
cod The chewing of raw liver is not unknown, or the 
mixing of blood with expectoration. I have found the roof 
of the mouth and soft palate of patients the seat of numerous 
bleeding points caused by the puncture of needles self- 
inflicted. Careful examination of the throat and nose in 
Aupidous ca<«5 should be made to etiminntc these as the 
sources of blood spitting. Auscultation of the lungs is 
always necessary, the possibility of prc-mcnstrual pulmonary 
haemorrhage in females, however, being borne in mind. Every 
bsmoptysis is not a sign of tubercular disease of the lungs. 
There is a stage in pulmonary phthisis in which ha:moptysb 
can occur without any sign of tuberculous disease in the 
lung. It is more than probable that a limited patch of 
tubercle is present in tlie lung in many of these cascn, but 
it is quite consistent with good health. Chavigny* says that 
tticTc exists an affection which simulates in such a manner 
the bztnoptysis of the pretubercular period that a medical 
man runs the risk of confounding the one with the other, 
or he is led to make a diagnosis of simulated harmopty^s 
when, notwithstanding numerous and periodical expectora- 
>ns of blood, the health remains good and the lung free. 

To this condition Jusscrand " in 1893 gave the name of 
tiaUm^su — a condition of an undoubtedly hysterica] 
Mature, yet 5uperv*ening after an injury. The expectoration 
has special characters by which it can be recognised. The 
bquid contents of the spitoon should be emptied into a 
conical glass and allowed to stand fur twenty-four hours, 
when it will be found to be divided into three layers. 
The uppermost layer, which is the most important, is very 
red: >t is rich in haimogiobin but poor in red blood 
corpuscles. The middle layer is not so highly coloured : 

* " DliigDOMic den Uahdici Sinialces." P. Ctinvigny, 1906, p. 407. 
Ljrow Uidkai itoj, p. 319- 



33 



DISEASES OF OCCUPATION 



od 



il appears as a thin, pale, rose-red disc ; while the low' 
layer has a greyish red appearance, and is made up most! 
of epithelial cells and decolourized red corpuscles. Nicol 
applies the term "pulmonary hysteria" to those cases in which,' 
owing to hicmoptysis of the type just mentioned, the diag- 
nosis of tuberculous disease has been made by even good 
physicians. In any case in which the particular features 
harmostalcmcsis arc present the examination should 
directed to ascertaining whether other h>'steriaU stigmal 
exist. A bacteriological examination of the sputum ought 
abo to be made, care having been taken — especially in » 
hospital — to prevent the patient mixing his sanguinolenl 
expectoration with the sputum from a tuberculous subject 
This examination is only of value when positive results 
have been obtained. We arc scarcely warranted in apply- 
ing the tuberculine test in these cases. While pulmonary 
phthisis is simulated, it is more frequently dissimulated or 
concealed. Men hide the fact as far as they possibly can 
in order to be allowed to follow their occupation. 

Heart disease and injury form an interesting subject from 
the Workmen's Compensation point of view. I do not refer 
to complaints of palpitation of the heart and of a sense of 
cardiac distress by men who seek to palm off their complaint 
as the result of an accident when, in all probability, it is the 
consequence of sexual excess and over-indulgence in the use 
of alcohol and tobacco ; nor do I allude to valvular lesions 
of the heart other than those connected with the aortic orifice, 
and disease of the aorta itself Sudden strain and^ injury ar6 
capable of causing cardio- vascular lesions which may perma* 
nently disqualify tlie individual for work. It is a debateabic 
point as to whether physical strain is capable of causing an 
aortic lesion in the absence of pre-existing disease of the valves 
or of the wall of the aorta itself. Medical opinion leans 
the theory of some pre^'ious weakness due to age or the res^ 
of alchohol. but especially to syphilis, or to the two or th 
combined. Were there nocxposure toscvcrcand uncxpccl 
strain the weakened heart and aorta of the middle-aged work 
man would probably serve his purpose quite well for many 
years to come: My own opinion is that it is quite possible 




INDUSTRIAL DISEASES AND ACCIDENTS 33 



for a comparatively healthy heart, free from valvular disease, 
to be taken uoaivares during severe strain, so that an injury 
ia inBicted whereby cither an aortic aneurism develops, or 
there is prodaccd regurgitation through the aortic valves. 
The lesion is certainly triiumatic. for at the autopsy the torn 
bot otherwise healthy valve can be found. Aortic regurgita- 
tion originating under these circumstances is an accident for 
which a claim under the Workmen's Compensation Act 
otigfat quite honestly be supported, provided always it was 
known that previous to the strain the aortic valves were 
healthy. I have known several instances of men whose heart 
was presumably healthy, for in them, although sought for. 
no cardiac bruit had been detected, becoming suddenly 
seized with precordial pain and faintncss after lifting a 
heavy weight, and in whose chest a little time after the 
accident an aortic diastolic murmur could be heard. Trau- 
DUtlc aortic rcguigitation has certain features that distinguish 
it from incompetence, the result of chronic endocarditis. The 
illness, for one thins, runs a much more rapid course ; it is 
more quickly fatal and less liable to be compensated. Many 
of the patients, the subject.^ of this accident, die within two 
years of the injury. Aortic incompetence cannot be simu- 
tUed, but a workman who is suffering from this malady 
m^ht claim compensation for an alleged injury received 
at work which previous knowledge of the heart of the indi- 
vidual by his medical practitioner, especially as regards 
aloobolic excesses and syphilis, with a statement of previous 
illnesses, might fail to support It must be borne in mind 
that heart dijicaie, of even the most dangerous nature, e^., 
aortic regurgitation, can exist for years and not give rise to 
symptoms until some sudden strain is experienced or some 
intercurrent illness, such as bronchitis, arises to break the 
balance of the circulation. 

Digestive TivubUs^ Vomiting, CoO^, &c. — The extension 
of the Workmen's Compensation Act so as to include metallic 
poisoning is bound to give rise to litigation between cm* 
ployed and employer. Vomiting and colic, although frequent 
and \'cry important symptoms of lead poisoning, arc sj-mp- 
. tons of such a large number of other diseases that care will 




necessarily have to be exercised in regard to setting a proper 

» value upon them. Vomiting is often a hysterical symptom. 
and IS often very resistant to treatment, while pain after mcab 
IS a subjective sensation, and, unless in its severest forms and 
attended Uy other signs, such as collapse, has to be weighed 
by the pliysician carefully before being accepted. The pns- 
encc of sudi other symptoms as hyperesthesia, hyperalgesia. 

tand diminUhed field of vision, would favour the diagnosis of 
hysteria and neurosis. There would be required an examina- 
tion of the vomited matter, for sometimes in these hysterical 
cases it 19 found that the solids are expelled while the liquids 
arc retained. So far as colic is concerned, the presence of 

■ a blue line on the gums, the absence of sulphocyanide of 
potassium in the saliva, and the presence of indican in the 
urine, would point to lead poisoning. The diagnosis would 

p be complete if lead were found in the urine. Constipa- 
tion, although usual in lead workers, may be replaced by 
diarrhcea, while workers in mercury and antimony, also 
brassfounders, usually suffer from looseness of the boweU. 
Within recent years cases of lead colic have been mistaken 
for appendicitis, and vtcf versA, in regard to which the absence 
of fever on the one hand and the presence of a blue line on the 

I gums suggest plumbism. 
It is desirable to call to our aid all the assistance we pos- 
sibly can to enable us to distinguish between pain of organic 
origin and pain that is hysterical or due to neurosis. Possibly 
_ in watching the pupil of the eye some help might be thus 
P obtained. In a healthy person the pupillary reflex to pain 
consists in a fairly rapid dilation of the pupil which had been 
previously contracted, the amount of dilatation being propor- 
tional to the intensity of the pain. On cessation of the pain 
produced by pressure for experimental or test purposes the 
pupil gradually returns to its normal dimensions. In hysteri- 
cal or neurotic patients complaining of pain, firm pressure upon 
the parts of tlic body referred to as the scat of pain is not 
followed by dilation of the pupil. It is an interesting fact. 
raoreovcr, that when a neurotic patient becomes the subject 
of an organic painful affection he too may exhibit thi 
pupillary reflex to pain when the tender part is pressed u 



( 



i 




INDUSTRIAL DISEASES AND ACCIDENTS 35 

but he will fail to exhibit the reflex phenomenon when the 
so-called hysterical points arc compressed. Without being 
an infallible guide the pupillary reflex enables us to dis- 
tii^uish with quiisi-certitude pain of an oi^nJc nature 
from pain that is imaginary or hysterical. 

Pkotphartts and Lucifer MaUh Making: Sesguisulpkide 
of Phospkorus 

Commercial phosphorus is obtained from bone a;th by 
treating it with sulphuric acid, filtering and evaporating the 
product. hcAtin^ this with charcoal, and afterwards distilling 
It Two kinds of phosphorus are in the market — the tokite 
or j-^-J/kc, discovered by Brandt, of Hamburg, in 1669, and the 
rtd or amorphous, discovered by Schrotcr. of Vienna, in 1845, 
and obtained from white phosphorus by exposing it in a 
dosed vessel for some time to a temperature of 2500C It is 
the white or yellow phosphorus tliat is <langerouK. From it 
Dntil recently, both in this and other countries, all the "strike 
anywhere " matches were manufactured. When pure this 
form of phosphorus is colourless and transparent, but when 
exposed to the light it becomes yellowish. It glows in the 
dark owing to absorption of oxygen. The grccnish-whitc 
light, or phosphorescence as it is called, can be checked by 
such essential oils as turpentine and eucalyptus. The glow 
of phosphorus is an Indication Chat oxidation is taking place, 
and that phosphorous and phosphoric oxides arc being formed 
along with, in all probability, ozone: Yellow phosphorus has 
to be kept in water.asitisextremely inflammable, and ignites 
at a temperature of 34''C. It is, too, extremely poisonous. 
Red or amorphous phosphoru.i can be handled with impunity. 
It does not take fire when rubbed on a rough surface; it is 
non-volatile, and when swatloK'cd is, comparatively speaking, 
1-poisonous. One to three grains of white phosphorus will 
jse death, but fairly large doses of amorphous phosphorus 
be given to animals ^\-ithout any bad symptoms following. 
Swedish, or safety matches, arc manufactured from red phos- 
phorus. These only strike on the box, upon a specially pre- 
pared surface. The matches themselves do not contain the 
red phosphorus. This is present along with antimony sul- 
phide in the paste that has been applied to the side of the 



DISEASES OF OCCUPATIOS 



outch-box. Tlie match heads contain potassium chlorate, 
Of chromatc, and other compounds ricb in oxygen, front 
which the oxygen required to induce conflagration is cvtJvwl 
Althouijh the Swedish matches made from red phospbonu m 
fwfcr. Ix>th from the potBtmoun point of view and from dan^ 
of fire, the fact remains that until recently only three lad 
a half tons of red phosphorus were used per year in Great 
Britain in the manufacture of matches, whereas six^ tons of 
white phospliorus were consumed. 

The manufacture of white phosphorus is a small industrj'. 
It i« carried on at Oldbury, near Rirmingham. Few of the 
men employed have suffered in health, owing largely to the 
precautions that are obser\-ed and the fact that, as the sub- 
stance is prepared in closed vessels, the workmen are not 
brought into direct contact with it. White phosphorus ii> 
uaed in the manufacture of the ordinary »tril<e>anywbeic 
matches. The match industry is an important one. The 
twcnty.two match manufactories in Great Britain give 
employment to upwards of four thousand persons, of whom 
three-fourthii arc females. It was the death of a luctfer 
match maker in London about eleven years ago, and the 
announcement in the daily papers of a considerable amount 
of ill-health in lucifer match makers, that brought the subject 
of industrial phosphorus poisoning before the public and 
gained for the trade an unen%-iable reputation. Out of the 
human suffering that was then experienced and the stigtaa 
under which the trade laboured good has come. The subject, 
after having been much discussed in Parliament, was re- 
fenvd by the Home Secretary. Sir Matthew White Ridley, 
to a small committee, composed of frof T. Thorpe, of the 
Government l-Aboratory, Dr Ceo, Cunningham, and myself^ 
to make an inquiry into and report upon (t) the nature and 
extent of the dangers attending the use of yellow and wtiite 
phosphorus; (3} the nicjins wliereby these can be lessetvcd; 
and O) the practicability of discontinuing the use of yellow 
anil white phosphorus The report to the Home Secretary 
Is publUhed as a Ulue Book. 

The mabdy of the lucifer match maker that is nMtt 
dreaded is what is known in this country as pbosphonis 
necrosis, or " phossy jaw," and in France as ma/ ckiimfmt, a 



MMfa 




INDUSTRIAL DISEASES AND ACCIDENTS 37 



kxalised inflammatory affection of the jawbone, extremely 
painful in the early stages, which lafits a long time, and 
iaririably ends in death of the bone. As it is only within 
the last few years that cases of phosphorus necrosis have been 
reported to the Home Office, it h difficult to say how many 
ludfer match makers in this country have sufTcrcd, The 
total number of cases of industrial phosphonis poisoning 
reported in this country until the year 1899 was 103, of 
which nineteen were known In have terminated fatally. 
Three other cases occurred in 1900, so that 105 cases of 
phosphorus necrosis are known to have occurred during the 
latter part of last century. Since then only eight or nine 
fresh caies of phosphorus necrosis have been notified.' 

The origin of the lucifer match is shrouded in obscurity. 
Several countries compete for the honour. There is the 
ftatefftent that the first lucifcr match was made in Stockton- 
oo-Tces. I have taken some pains to investigate this matter, 
for until recently 1 ivas of the opinion tliat lucjfer matches 
wtre invented in Vienna ; but it would now appear as if the 
Austrian capital had been in the early years of the match trade 
rather concerned with the production than the discovery of 
lucifer matches. A closer study of the subject leads me to 
regard Englandas the home of the industry, and John Walker, 
a dispensing chemist of Stockton-on-Tees, as the inventor of 
the lucifer match. Almost for equal recognition stands out 
Sir Isaac Holden, M.1*. Mr. Walker died at 12, The Square. 
Stockton-on-Tccs, May I, 1859,31 the age of 78, For several 
years before his death he had realised a good income from 
the sale of bis matches. I have seen facsimiles of the 
matches. They are narrow, flat, wooden splints, 3 inches in 
lei^h, and have a red-tipped head } inch in length. The 
notches were sulphur-tipped as well. Walker's first friction 
matdtes were made of cardboard, and were sold at the rate 
of 6fiy matches for a shilling. Subsequently he substituted 
wood for the cardboard. A piece of sandpaper shaped like a 

• Dr. T. U. Lcggc, Mcdicsd Inspector of Kactorics, inTorms uic 

[Dec., 1907) Ihatsinc* 1900 inclusive ihcrc Imvc been twulvc cas«a of 

^jfeoBphoroa occrutis aotiliod, and of these five proved iMul to 

^^Kftat Brit.iin all cues of phosphorus necrosis, wlietber mild or t^vere, 

^^K reported. It if thit circometancc which renders a compuison 

P fettreen British Stat istics and those ot other countries difficult. 



38 



DISEASES OF OCCUPATION 



cocked hat was sold wich th« matches, into which the ms 
was inserted and drawn quickly to get the necessary expli 
Walker's books are still in existence, and in these are 
tained entries of sales with the names of the purchasers 
dates. From these books wc Icarn that be was makir 
matches for sale in 1827. Sir Isaac Holden has been 
credited with priority as to the invention ; but in an auto- 
graph letter dated May 3, 1892, Sir Isaac says his own 
match was not invented until N'ovemher, 1829, and that 
this date he was not aware of Walker's discovrry. Sir h 
(then Mr.) Holden nc\-er attache<l to his own invention 
importance be might, nor did he take out a patent for it 
the Liitis Mtrcury, January 1, 1894, is a detailed account 
a meeting held at Oakwortb House to present Sir Isaac 
Ilolden, Bart.. M.I'.. *vith an address from his constitu* 
of the Kdghley Parliamentary Division of Yorkshire. II 
the course of liis reply the venerable parliamentarian said he 
had almost given up claiming any credit for the invention tA 
lucifer matches, as he had been anticipated in that di5co\'er>' 
by another inventor by about two years. By this renounce- 
ment of the claim the honour of the discovery rests with John 
Walker, the dispensing chemist of Stockton-on-Tees, whose 
body is buried in Norton Churchyard, a mile and a half from 
Stockton. Walker was never the recipient of any Royal 
favour, nor during his life was any special notice taken of 
the great sen'ice he rendered to mankind. As with other dis- 
coveries, many minds were directed to the same subject at 
the same time. Walker outstripped others both at home and 
abroad, and was selling matches in Stockton years before they 
were being made and sold in Vienna. Stephen ROmer, a 
merchant in Vienna, is believed to have been the first to hav 
made phosphorus stable in the air and incande'ieent by frieti< 
when mixed with incombustible substance*. Komer is 
posed to have bought the invention from a young Hungaria 
llartholomiius Irtnyi, who was a student of chemistry at 
timein Vienna. This was in 1S32. France has also advanc 
a claim to the invention. Whatever doubt surrounds 
origin of the lucifcr match, it was certainly in Austria that 
the fourth decade of last century the manufacture became an 
industry on a tai^e scale. For a period Vienna 



ta controllQU 



INDUSTRIAL DISEASES AND ACCIDENTS 39 



the markets of Europe The manuracturc of matches had 
gone on for a few years without any mishap occurring, until 
1S38, when Dr. Lorinser, of Vieaiia, diagnosed phosphorus 
necrosis in a female worker, Marie Jankovits. This is the 
fiist authentic case of industrial phosphorus poisoning on 
record. Three years previously the manufacture of lucifer 
Dutches had been forbidden by several of the German States 
as being too dangerous, not so much to the health of the 
workpeople as to the safety of the community on account of 
ficB. Shortly after 1838, Dr. KnoU ha%-ing reported other 
coses of the malady, the Austrian Government appointed a 
commission to make an inquiry into the conditions of work 
in the seven match factories that at the time existed in Vienna. 
Although certain recommendations were mMit: by the com- 
mittee and were given consent to by the States Council in 
1846. they never became effective, for between i866 and 
1S75 there occurred 1 26 cases of phosphorus necrosis in the 
hospitals of Vienna alone. 

That is the story as it bears upon Austria, and to which, as 
concerns it: industrial aspect:$, wc shall immediately return; 
but, as already stated, other countries had advanced a claim 
to having invented the lucifer match. England's share in the 
cfiscovcry has never been fully recognised, hence these details 
of the invention. In 1S31 Charles Sauria,astudent at thcCol- 
legc of Arc, at Dile. showed that matches could be made from 
a mixture of phosphorus, sulphur, and chlorate of potassium ; 
but a3 he had no money to proceed with his invention, he 
detailed the processes of manufacture to his teacher of physics, 
Pfx>fessor Nicolet, who in a moment of enthusiasm fur his 
pupil carried the information to Johann Friedrich Kammcrcr, 
then a political prisoner in the Hohenaspcrg of Wurtemberg, 
who subsequently established a match works in Germany. 
Meanwhile Sauna, having finished his studies, had settled 
dowTi as a doctor of medicine in Sl Lothain, in Jura ; but as 
be was not successful in the practice of his profession, an 
appeal was made by friends in tS84 to M. Jules Grivy, 
I^csident of the French Republic and a compatriot of 
the inventor, for pecuniary assistance to Sauria, who, 
after enjoying the pension a few years, died in 1895 at 
■the age of 84. Sauna's lucifer match was far from being 




40 



DISEASES OF OCCUPATION 



perfect Binoxide of lead was substituted by him fa 
potassium chlorate in order to soflcn the character of the 
explosion on striking the match. In the works carried on b] 
Sauria, as phosphorus necrosis was not unknown among tl' 
workmen, an attempt was made to eliminate phosphc 
altogether from the factory, and to make lucifcr matches 
of chromate and chlorate of potassium, peroxide of lead, an< 
sulphide of antimony. In 1902 old students of the Colle 
of Arc appropriately placed on record on a commemorative 
tablet the invention by Sauria, while the town of Ddle, tht 
birthplace also of the illustrious Pasteur, named one of it 
streets after him. 

Between 183; and 1845 the production of lucifer matche 
increased with great rapidity over the whole of Europe. M 
the latter date, according to the interesting historical informa 
tion supplied by Dr. Ludwig Tcicky,' there were in Nurem-^ 
bci^ four match factories, giving employment to ) 50 to 200 
workmen, and three factories in LyonsL There were also 
works in Berlin, Stuttgart, Zurich, Strasburg. and Paris, but 
as a manufacturing centre Vienna remained supreme. Tht 
three large factories of Romcr, Preshcl, and Siegl in Vienna 
had a large export tnide. in which smaller factories shared.] 
As the smaller works, for want of capital, could not compct< 
with the lai^er and better equipped, the smaller pU 
gradually dropped out of existence, a fate from which tl 
larger works were subsequently also not spared, for by 185^ 
there were only eight factories in Vienna and Lower Austr 
giving employment to sSo men and 1,450 women. Even at^ 
tliis period attempts were being made to find Jn potassium 
chlorate a safe substitute for the dangerous white phosphorus. 
The match industry in Vienna gradually declined, but not 
on account of the character of the products, for at the 
Paris Exhibition in 1855 the three first prizes awarded 
lucifcr matches went to Vienna. In consequence of the^ 
deamcss of the wood required for the splints the in- 
dustry migrated to Bohemia and Styria, where wood wa 
cheap, and where, as also in Galicia, it still gives employmcnl 
to lai^c numbers of persons. In 1855 Austria exported twol 

• " Die Phosphomckrosc Ihrc Vcrbrcitung in Oslnrdicb und Dehr 
Unacticn." Wicn, Franz Dcnlicke, 1907, 



INDUSTRIAL DISEASES AND ACCIDENTS 41 



million florins' worth, or 22,000 cwt of matches; in 1866 
the export trade reached its highest point, viz., 57,000 cwt 
Fiwn this date the Austrian manufacture of matches has 
steadily <lccline(i in the face of Swedish competition, with its 
cheaper wood, and the imposition of high protective duties 
b>- countries to which Austria had hitherto exported. For 
wood, which in Sweden cost only four to Rve florins, thc 
nutch manufacturers in Bohemia had to pay seventeen to 
eighteen florins, while Sweden, with its easy access to the sea 
and cheaper freights, gradually captured m.irkets jireviously 
held by Austria. This has certainly been the case as concerns 
the Eastern Asiatic and China market<i, where, too. within 
recent >'ears, a formidable opponent has arisen in the com- 
mercial activity of Japan. The rise and fall of the Austrian 
match industry is an interesting social and international study, 
since to-day there is no longer even one match factory in or 
near Vienna. What part in the future Japan will play as a 
competitor in the lucifer match industry it is impossible to 
say. Her maritime ascendancy and proximity give her special 
privileges so far as the Chinese and even Indian markets are 
concerned, while the cheapness of wood in the island, the low 
vragcs, children's labour, and low freights enable her to com- 
pete in even distant markets with some of the older lucifcr 
match -producing countries of Europe. In [904 Japan 
produced 28 million francs' worth of matches, and gal/e 
employment to zt^oo workpeople {6,070 men and 15,335 
women and young persons) ; whereas Great Britain, with 
her eighteen factories in 1901, gave employment in this 
industry to 3,too women and 1,500 young persons. The 
following tabic, taken from Dr. Tcleky*!! monograph, Is not 
without interest in support of the opinions that have ju^ 
been expressed and the facts stated. In the lucifer match 
industry — 

cinplofS 21,400 workpeople. 
„ 15,668 



Japan 

Russia 

Italy 

Sweden 

Germany 

Austria 

HungaiT 

Great Britain 



6,joo 

5.655 
4.8 IS 
4,611 

a. 1 75 
4.150 



n 
•I 
>r 



42 



DISEASES OF OCCUPATION 



In 190$ Japan, with her production still increasing, sent 
to Australia and the United States of America 33,000 francs' 
worth of matches, and 1 3400 francs' worth to Egypt. 

When a member of the Lucifer Match Committee, it was- 
my duty and privilege to visit match works in England. Scot- 
land. Beigtum (including; FlandersX France, and Gcnnany. 
Most of the recently built factories arc up-to-date buildings, 
but there are a few that are quite out of keeping with modem 
requirements. It was because the manufacture of lucifer 
matches at the commencement of the industry required, prac- 
tically speaking, no machinery, but only a small amount of 
plant, and matches were made by hand, tliat any kind 01 
dilapidated building seemed to be considered good enough fo: 
the purpose of a match factory. Hence the wretched stro 
tural conditions of some of the factories I have visited, also 
the circumstance of tlie manufacture of lucifer matches being 
clandestinely carried on as a domestic industry and attended 
by serious consequences to the workers. 

Most countries have consumed the matches manufactu 
within their own borders, but others, such as Norway, 
Sweden, Belgium, and Great Britain, have been large ex- 
porters as well. Japan, as already stated, manufactures and 
exports a lai^c quantity of matches. It is difHcuIt t 
ascertain to what extent lucifer match making is a home 
industry in Japan. Two kinds of matches arc made there, 
(l) the ordinarj- strike- any where, and (2) safety matches. 
The work is carried on under certain regulations. There arc 
no such factory laws in Japan as wc have in thi« country, an 
yet among the requiremenu it is insisted that there sha! 
be a separation from each other of the different departments, 
namely, dipping, drying, and boxing, the provision of ventila- 
tion by hoods and fans, the prohibition of employment of 
persons when their teeth are decayed, the interdiction of 
food taken into and eaten in the factory, and of the presence 
of a larger percentage of phosphorus in the paste than 10 per 
cenL In Japan no match factory can be built without the 
consent of the Government, and no workers can be employ 
under sixteen years of age. 

The head of an ordinary strike-anywhere match con 



■c 



tNDUSTRIAL DISEASES AND ACCIDENTS 43 



■ glue, phosphorus, chlorate of potassium, powdered glass, and 
magenta, or some such colouring agent. The paste, or 
"composition," contains on an average 5 per cent of phos- 
pfaonj.s. Into this comi>i>iinti. when spread out moist and 
s%htly warmed, one end of the wooden matches, or splints, 
ts dipped, several hundreds of them at a time. These arc 
then taken to a drying chamber. After drying, the frames 
containing the matches arc stripped and the matches are 
boxed. It is in the mixing of the paste when done by hand 
in open vessels, and in the dipping and boxing of matches, 
that the workpeople arc exposed to fumes that become a 
menace to health. The mixing of the paste ought always 
to be done in closed %'essels, mechanically if possible, and 
the dipping and boxing of the matches carried on close 
to a running fan. During the process of dipping, the 
fumes of the phosphorus arc quite visible. They can be 
seen rising for a few inches above the dipping plate and 
travelling towards the fan. These fumes are rich in phos- 
phorous oxides. Professor Thorpe exposed decayed human 
teeth to the fumes of phosphorus for twelve hours, and he 
found that they lost 0*37 per cent, of their weight, and that 
carious teeth when exposed to a dilute solution of phosphoric 
acid (i per cent.) lost 89 per cent, of their original weight. 
The atmosphere of an ill-ventilated lucifer match factory 
simply recks with the garlicky odour characteristic of phos- 
phorus. Thorpe found 0x12 milligramme of phosphorus in 
100 litres of air in the dipping room of a match factory, and 
in the same quantity of air in the boxing room 0'i2 milli- 
gramme of phosphorus. Since during several hours of each 
working; day the dippers and boxers arc inhaling this 
poisoned atmosphere, the fumes become dissolved in the 
saliva of the mouth and exerci:se a solvent action upon the 
teeth. It is not alone the air breathed that is the source of 
danger. The poison clings to the fingers and hands of the 
workpeople. On examining the hands of a boxer they arc 
seen to be deeply stained by the dye given off by the heads 
of the matches, and they emit the characteristic garlicky 
odour. They glow in the dark. On analysing the water in 
which twenty-two workpeople had washed their hands on 




44 DISEASES OF OCCUPATION 

leaving the factory, Thorpe found 375 miltigrammcs of pbt^^ 
phorus, an amount equal to 4*2 in illi grammes of phosphonil 
per person for each ten hours' work. 

Phosphorus nccrusfs. or phos«y jaw, is the unique malady 
of lucifcr match makers. It is a localised maiiircstation of 
phosphorus poisoning. That the system, generally speak- 
ing, is also affected as well is more than probable. French 
physicians describe a general morbid condition of the body, 
or a cachexia, met with principally in female workers, charac- 
terised by pallor of the face, dyspepsia, albuminuria, and a 
tendency to bronchitis, to which the term phospkorisme has 
been applied. During my visits to the French match works 
I had the opportunity of discussing with Dr. Amaud, of 
Marseilles, the liability of young female woricers to bron- 
chitis, as it is not a common a^ection in this countiy. In his 
opinion 28 per cent of the young women suffered from 
bronchitis, but there was no tendency for the disease to 
become tuberculous. Arnaud did not find, as some French ' 
physicians have maintained, that there is a greater predispo- 
sition on the part of the pregnant lucifer match maker lo 
miscarriage than women employed in other occupations. 
My experience confirms that of the Marseilles physician. 
This is an interesting and important point, because phov 
phorus in the form of a decoction of match heads is frequently 
resorted to by women for the purpose of inducing abortion, 
always with extremely painful consequences, and often with 
a fatal result 

In Great Britain phospJiorismt^ or the constitutional form 
of phosphoois poisoning, is not of common occurrence The 
maJady that is dreaded is phosphorus necrosis. The presetice 
of decayed teeth predisposes a match maker to the disease, 
for the phosphorus fumes penetrate carious teeth, and readily 
induce a periostitis, or acute inflammation of the covering of 
thejaw-bonc. The gum becomes swollen, and both it and 
Aa jaw-bone painful. Sooner or later pus forms, and 
although the tooth, or teeth, are extracted, the pain continues, 
but in a less severe form. The inflammation gradually 
extends lo the bone, which undergoes a process of slow 
destruction. For months pus keeps oozing out into 




INDUSTRIAL DISEASES AND ACCIDENTS 45 

mouth in minute quantities, some of which is swallowed, and 
tends to induce a chronic toxjemia. By means of the use of 
antiseptic mouth-washer the morbid process gradually ceases 
by a piece of dead bone being thrown off. or the decayed 
bone is removed by surgical operation, when the patient 
recovers, with or without facial deformity-. 

Opinions are divided as to the causcof phosphorus necrosis 
to tucifer match makers. Is it tlie result .solely of phosphorus 
fumes acting upon the jaw-bone through decayed teeth 
setting lip inflammation of the bone, and allowing therefore 
the micro-organisms present in the mouth to cany the morbid 
processes further; or is phosphorus necrosis, as Profes&or 
Stockman, of Gla^ow, infonns us, a tuberculous affection of 
the jaw-bone, and due to infection by the tubercle bacillus? 
My own opinion is that the disease of the bone is the result 
of a mixed infection, and that phosphorus fumes, by primarily 
tiKlucing pathological changes in the teeth and jaw-bone, 
make it possible for micro-organisms to carry on their baneful 
operations. 

There is, however, something peculiarly human in phos- 
phorus necrosis. Dr. L. v. Stubcnrauch, of Munich, tried Co 
produce phosphorus necrosis in dogs by exposing them to 
the vapours given off from burning phosphorus, but without 
any untoward results, Other dogs, some of whose teeth had 
been extracted, were exposed in the boxing rooms of laige 
match factories for six months without any evil consequence.s. 
Experience and experiment alike show that it is practically 
impossible to reproduce in animals the picture of phosphorus 
necrosis exhibited by man. Stubcnrauch maintains that the 
first stage tn the morbid process is thrombosis of the small 
blood-vessels of the bone {Archiv. J. Klin. Chir., Berlin. 
April 7. 1899). Lcwin, of Berlin, docs not believe that it is 
primarily necessary for a lucifer match maker to have decayed 
teeth. The phosphorus fumes, in his opinion, inflame the 
gums in the first instance, and as a consequence there is 
induced a septic gingivitis, which is followed by disease 
of the bone. In Wegncr's experiments with phosphorus 
upon animal-s the cancellous part of the bone became 
hard and sclerosed. Although phosphorus has some special 




46 



DISEASES OF OCCUPATION 



ht 



predilection for bone, the fact that in animals exposed to it 
necrosis of the jaw-bone docs not follow suggests that in the 
human subject there is probably, over and above phosphorus 
fames, some other factor in operation, 

Phasphorus when absorbed is only slightly altered in th' 
blood. When exposed to the air phosphorus is slowly 
oxidised, but this occurs hardly at all in the blood-vcssds. I 
for example, to freshly drawn arterial blood phosphorus is' 
added, and the glass tube is hermetically sealed, Ihe bright 
red arterial colour is not lost earlier than in a conirol experi- 
ment where none of the metalloid is used. Phospho; 
therefore, cannot be said to absorb oxygen from the blood 
that the amount of pbosphoric acid formed in the blood mu!>t 
be too small to cause poisoning. The blood loses its power 
of clotting, probably owing to Che action of phosphonis upon 
the blood ferment. 

Lucifer match makers are liable to another afTcction of 
bones, one which haa a sfiecial relation to the constitution, 
effects of phosphorus poisoning. When visiting the raatcl 
works in Grammont, Belgium, I had the opportunity 
meeting Dr. Brocoorcns, who has had large experience 
match makers and their diseases. He drew my attention to 
the fact that several of the men who had been employed 
as dippers in the factories, and who in their earlier years had 
suftercd from phosphorus necrosis and had recovered, ex- 
htbitcd an unusual tendency to fracture of their long bones, 
especially the femur, often on the slightest exertion. The 
town of Grammont contains six match factories, which give 
employment to upwards of l.ioo persons. During the thirty 
years Dr. Brocoorens has resided there he has treated 
upwards of thirty cases of spontaneous fracture of the long 
bones consequent upon such simple muscular cfTort as that 
required when walking to lift the foot from the roadway to 
the pavement. Spontaneous fracture of the bones has not 
occurred in England with anytliing like the frequency as 
in Belgium, but Dr. Garman, of Bow, for many years medical 
oHicer to Messrs. Bryant & May's works, informs me that 
he has known of nine cases, and Dr. Dearden, of Manchester 
(jSr/V. }fed. /tmm., iB^p, vol. iu p. 270), has reported the 





INDUSTRIAL DISEASES AND ACCIDENTS 47 



occurrence of the accident in two dippers, " each of whom 
tus had separately and at difTerent times both thighs broken 
in A ridiculously simple fashion." Dr. Kocher, of Berne, has 
had experience of a match maker who broke his thigh-bones 
five times. The readiness with which the long banes snap in 
match makers indicates that the bony tissue is in some way 
or other influenced by phosphorus or its compounds, where- 
in chey are unable to withstand external violence. It ts 
Dearden's ofunion that the bones of match dippers contain 
an excess of phosphoric acid, which combines with the pre- 
existing neutral phosphate of Itme to form a slightly acid salt 
and thereby to cause the /ragililas ossiufn of luctfer match 
makers. 

In Great Britain less than i per cent of the match makers 
hai-v suffered from phosphorus necrosis, in Switzerland it 
was formerly l'6 to 3 per cent, and in France 2 to 3 per 
cent Of 51 cases of phosphorus necrosis communicated to 
me by Dr. Garman 9 ended fatally. Eighty-three per cent, 
of his patients recovered and returned to work. Of the 51 
cases 31 were females and 20 were males. In the women 
the upper jaw was affected 15 times and the lower i6. In 
the men the numbers were respectively ti and 9. Dr. 
Brocoorens found that the dippers were more liable to 
necrosis of the upper jaw, and that in boxers, who are 
tmially females, it was the lower jaw that was more frequently 
affected. When phosphorus nccrasis has attacked the upper 
jaw the inflammatory process is apt to extend to the brain and 
induce a septic inflammation, which in every instance has 
been fatal. A person may follow his occupation in a match 
works for years without suifcring, or he may have left the 
works for two years or more when unexpectedly symptoms 
and physical signs of phosphorus necrosis show themselves. 
The ages at death of Carman's patients were 19, 19, 3i, 
22, 22, 22, 23, 27, and 27. It does not always require an 
exposure of many years to the fumes of phosphorus for 
3 fatal result to follow. In two of the patients included 
above pulmonary consumption doubtless contributed to the 
faul result. 

The questions submitted by the Home Secretary to Pro- 




48 



DISEASES OF OCCUPATION 



feasor Thorpe and myself were briefly whether anythi 
could be done to render lucifer match making from wlit 
phosphorus a more healthy employment and whether 
harmless substitute could be found for the dangerous metal- 
loid. Since it has been recognised that the fumes of white 
phosphorus by penetrating carious te«th must play some 
part in causing necrosis of the jaw-bone, periodica! examina- 
tion of the teeth of the workpeople by a qualified dentist, 
and treatment when necessary, improved ventilation of the 
workrooms, reduction of the amount of phosphorus in the 
paste for heading the lucifers, and stupenston from the 
factory of all workers on the slightest appearance of symp- 
toms, have done much to diminish phosphorus necrosis in 
match makers. Only twelve cases of phosphorus poisoning 
have been reported to the Home Office since 1900, and in 
three of these the disease probably existed before the new 
rules were drafted. The introduction of machinery whereby 
the wooden splints are cut, the matches dipped, dried, and 
boxed without being handled by the workers, has in the 
Diamond Match Works. Liverpool, been followed by the 
greatest success. When these processes are carried on in 
Xargc, well -ventilated workrooms and the mixing of the 
paste takes place in covered iron vessels provided with 
ventilating shafts, the risk from phosphorus necrosis is con- 
siderably diminished. The fact remains, however, that so 
long as white phosphorus is used absolute freedom from ris k 
to health cannot be assured. ^M 

Manufacturers have, therefore, been obliged to turn theJ^^ 
attention to the use of a harmless substitute for white phos- i 
phorus. The difficulty at first was to produce a satisfactory ' 
strike-anywhere match, for valuable as the Swedish or safety 
match is, the public demand for this kind of match does not 
increase in the same proportion as for the ordinary lucifers. 
The workpeople on the Continent have suffered from phos- 
phorus necrosis as much as, if not more than, our own match 
makers. Denmark, Switzerland, and Holland have for a few 
years interdicted the use of white phosphorus and the sale 
of matches made from it These countries only manufac- 
tured for home consumption. They never exported to any 



^— ^t*r^ — 




INDUSTRIAL DISEASES AND ACCIDENTS 49 

«stent, if at alL In France, where the manufacture of 
niatches is a State monopoly, and where the workers had 
to be compensated for injury to health in consequence of 
tlieir occupation, the claims for compensation hiid a few 
years ago ri:ien to such a height that the Government was 
oUiged to make an cflbrt to improve the lucifer match 
industry. Much of the ill-health complained of by the 
workpeople was doubtless in no way the consequence of 
tfadr occupation. The figures arc interesting. In the match 
ft-orks at Pant:n-Aubervilliers, near Paris, there were reported 
p cases of phosphorus intoxication in 1894; in 1S9S, 125; 
in [89G the number rose to 223, or one-third of the efTective 
force of ihe factory. At these dates the paste for heading 
the matches often contained, in addition to small quantities 
of lead, 20 to 30 per cent, of phosphorus. In one year, 
January 1 to December 31, 1896. the State paid to the 
workpeople at the Pantin-Auberx-illiers match factories 
400,000 francs, or 630 francs per person employed over 
and atMve his wages. Apart from this undesirable drain 
upon the Treasury it was felt that the time had come when 
something M'ould have to be done to alter the conditions 
of labour in French match works. Meanwhile the Belgian 
Government had olTered a prize of 50,000 francs to any 
person who would invent a safety strike- anywhere match 
free from white phosphorus. France solved the problem. 
After many trials MM. Sev&ne and Cahen demonstrated 
that in scsqutsulphidc of phosphorus was to be found a sub* 
stitute practically capable of accomplishing all that white 
phosphorus could do without causing symptoms of poisoning. 
These scientists gave daily 3 centigrammes (|rd grain) to 
guinea-pigs over a considerable period without producing 
symptoms of intoxication, whereas 3 milligrammes (./sth 
grain) of white phosphorus similarly introduced killed 
guinea-pigs very rapidly. 

It was thought at first that matches made from sesqui* 
sulphide of phosphorus would not carry well across the 
ocean and that they would not keep well in all climates, 
but experience has not confirmed these forebodings. The 
sesqutsulphidc is almost an inodorous powder, and is, prac- 




Sfi 



DISEASES OF OCCUPATION 



jvcd J 



dcally speaking, non- poisonous. It may contain a trace o 
red or amorphous phosphorus and at times give ofT a slight 
odour of sulphur. The results of the substitution of phos- 
phonis sesquisulphide for the harmful white phosphorus at 
Fantin-Aubcrvillicrs were at once apparent in the improved 
health of the workpeo]>le and in the cessation of monc 
claims for injured health. Dr. Courtois-Suffit, MtsHcal 
Inspector of the French match factories, informs mc that 
lacifer match making is no longer regarded as a dangerou 
trade by his Government. The sesquisulphide has found its 
way into Great Britain, and its use has been followed by 
success. One good, but quite unexpected result of the 
substitution of the harmless for the dangerous form of 
phosphorus in match making is the diminution in the 
severity of symptoms and in the number of cases of fatal 
suicide due to the use of matches. Phosphorus poisoning, 
which was the cause of a few deaths eip'cry year in the Koyal 
Infirmar>', Newcastle, has, practically speaking, disappeared 
from our statislic.iI tables, .ind in the patients admitted tha, 
symptoms are usually less serious, a circumstance which 
shows that in this city, at any rate, the matches that are sold 
have been mostly prepared from the sesquisulphide. The 
paste from which these non-poisonous matches are made ii 
as follows : — 



1 



Sestiuiftulphide of 


phosphorus 




... 6 parts. 


Chlorate of pouusJum 






... 24 „ 


Oxide of line 


... 






... 6 „ 


Red ochre ... 









... 6 ., 


Powdered glass 


... 






... 6 „ 


Glue 


... 






... 18 „ 


Water 


..• 






"• 34 ., 



Since the introduction into France of the manufacture 
the sesquisulphide match there has not been in the ractorics 
one case of phosphorus poisoning, nor has there been any 
explosion or fire in any of the match works. The slight 
trace of sulphuretted hydrogen given off by the new material 
has not produced illness of any moment. Readiness to < 




INDUSTRIAL DISEASES AND ACCIDENTS 51 

fire and the evolution of unwholesome gases have been pre- 
Tented by tbe regulations requiring that the sesqiiisulphide 
shall contain 3 to 4 per cent, of red phosphorus; this prevents 
the formation of unstable subsulphides. In the manufacture 
of matches by phospbonis sesquisulphide, machinery i^ fast 
replacing hand labour, the economic advantages of which 
change arc readily apparent, while the health nf the workers 
is in all respects improved. For the last seven years the new 
method of manufacture has been in use at Pantin, where with 
tfw impro\"ed machinery 2,500,000 matches arc made every 
day. This has reduced the number of workers employed, 
bat it has purified the industry. 

In our own country a similar improvement has been 
observed. Mr. Bartholomew, managing director of Messrs. 
Bryant &. May's works, l^ndon, writes to me that " We arc 
well satisfied with our long trial of the new composition. 
There has not been, and there cannot be, from the nature 
of the composition, any sickness among the workpeople." 
In the future wc shall hear less and less of the frightful 
ravages of white phosphorus. The manufacture of lucifer 
malchca is therefore an illustration of at least one industry 
which, from being of a dangerous and unhealthy nature, has 
become by vigilance and scientific invention comparatively 
speaking healthy. This change for the better has been 
secured without great cost to the manufacturers, for it has 
not neces-titated any great change of plant, and yet what a 
^dn it has been to hundreds of workpeople who have to 
earn their living in the trade I 

Although in preceding |>ages sesquisulphide of phosphorus 
has been extolled as against white phosphorus, it is only right 
to mention that while its use in the manufacture of matches 
has so far been free from danger, it acts in some instances as 
an irritant, causing conjunctivitis and oedema of the eyelids, 
ilso eczema of the skin. To obviate this the workpeople in 
Fiance engaged in the manufacture of the sesquisulphide 
bathe their eyes, and douche their nostrils, twice a day before 
leaving the factory with an alkaline solution of bicarbonnte of 
soda, and since adopting this preventive line of treatment 
the inftajnmatory troubles have ceased to exist. At first the 




5* 



DISEASES OF OCCUPATION 



workmen rcru»cd to adopt these precautionary measures, 

this initial diflficuhy having been overcome the workpeople ^J 

themselves are now reeling the bendit of them. ^M 

The treatment of phosphorus necrosis is mainly preventive. 
New workers on being taken on at the factorj* shonld be 
medically examined, special attention being paid to the state 
of their teeth. There ought to be periodical examination bya 
dentist of the teeth of all workers in a match factory, with 
power to suspend when necessary. Personal cleanliness is a 
requisite, and the frequent use of antiseptic mouth-washes a 
desideratum. The workrooms should be well ventilated, and 
fans should be running to withdraw all fumes away from the 
face of the workers. Washing accommodation should be 
ample, hot and cold water being provided along with plenty 
of soap and towels. On complaint of pain in the jaw, the 
mouth should be examined bya dentist, loose and carious teeth 
should be extracted and the use of antiseptic mouth-washes 
encouraged. Once phosphorus necrosis has developed the 
malady may be treated simply by keeping the affected part 
clean as far as possible by roouth-washes and by maintaining 
the general health of the patient by good food and fresh air; 
but healing is a slow process, for the disease may go on for 
several months before it is arrested or the piece of dead bone 
thrown ofll To expedite recovery sui^cons occasionally 
remove by operation Uie dead bone. Eighty per cent, of the 
cases of phosphorus necrosis recover, whether dealt with 
sui^'cally or treated by antiseptic washes. The most fatal 
cases arc those where the disease extends from the upper jaw 
into the base of the skull and .sets up septic meningitis, or 
those in which, owing to rather profuse and protracted sup- 
puration of the jaw-bone, pus keeps escaping into the mouth, 
mixes with the food, and causes toxsmia or gains access 
to the respiratory canals and lights up pulmonary disea.<;e. 

The question of the total prohibition of while phosphorus 
has frequently been discussed. Elsewhere 1 liave expressed 
the o|nnion that nothing short of its total abolition will 
render the manufacture of lucifer matches a safe industT>' 
from a health jxiint of vieiv, but there arc economic and 
commercial considerations which cannot be altogether ignored 






INDUSTRIAL DISEASES AND ACCIDENTS 



^■. 



tven in the lucifer match trade. Only by international 
agreement can this question be settled. At the Bcme 
Congress (1906) the representatives of the British Govern- 
ment did not .<iee their way to join in the abolition movement 
unless other lar^e exportint; countries co-operated. Readers 
need only refer to the figures and facts given in an early part 
of this chapter which deal with the rapid industrial advance 
of Japan, and to remember the unwillingness of Japan at 
the Bemc Congress to co-operate with oUrer countries in the 
movcnKmt for the abolition of white phosphorus, to find an 
explanation of the attitude assumed by the British repre- 
sentatix-es in regard to this subject 

In these pages I have dealt with the signs and s>'mptoms 
of industrial jAosjthorus poi.'ioning. When per-ions have 
accidentally swallowed phosphorus, or drunk a solution of 
match heads with suicidal intention, they have usually 
become jaundiced by the third day, and most of them have 
died shortly afterwards from toscEmix After dcatli the 
liver and kidneys have been found to hitvc undergone fatty 
degeneration. Recently a child two year$ of age was 
admitted into the Royal Victoria Infirmary, Newcastle, who 
had sucked several match heads. She died within 30 hours 
of the event, and although she was never jaundiced, there 
was yet found at the autopsy advanced fatty degeneration of 
the liver and kidneys. The case is exceptional as regards 
the rapidity of death, absence of jaundice, and the presence 
of extreme fatty degeneration of the internal organs in the 
short time. The matches had been made in Flanders and 
contained white phosphorus. The case serves to illustrate 
this other important point— that should Great Britain inter- 
dict within her own borders the manufacture of matches from 
while phosphorus, Farliament would at the same time have 
to prohibit the importation of " 5trike-an>'wherc " matches 
made from white pho-iphorus ; and while this might be done in 
inttu^sts of the health of the people, it would be regarded 
lysome persons asa form of protection to which, commercially 
at any rate, this country has not yet committed itself. 



m 



CHAPTER II 

DISEASES DUE TO GASES, VAPOURS, HIGH TEMPERA- 
TURES, ETC. 



Card(m Diainde ; Cartonie Add (CO,) 

AS a poiflonous gas carbonic acid can hardly be com- 
pared with carbon monoxide, (CO) the symptoms of 
poisoning by which develop with great rapidity. Carbonic 
acid is, fortunately, a more feeble poison. More people 
are brought under the influence of CO, than CO, since 
it is the gas which is present in badly ventilated dwelling- 
rooms, workshops, and factories. When exposed to small 
quantities of this ga<i for a long period the vital resistance^ 
of the organism is reduced and the way is paved for disease. , 
COa is found in ordinary atmospheric air to the extent^ 
of '04 per cent., but it must be present in larger quantities 
to cause such symptoms of poisoning as headache, vertigo, 
buzzing in the ears, heavy sleep, and loss of consciousness.] 
Three [>er cent, of CO3 in the air causes difHculty of 
breathing, 6 per cent causes palpitation and headache, 
while upwards of 10 per cent, induces unconsciousness. IdJ 
poisoning by CDs ihc breathing is at first quickened : it is 
short and gasping, the beat of the heart becomes slower, the 
extremities cold and cyanosed, and death comes with 0*] 
without a convulsion. It is the mode of termination of life 
in many cases of heart disease. There are few instances In 
which carbonic acid without tlie presence of other gases at 
the same time— .r^., carbon monoxide — is breathed in 
sufficient quantity by men and women at work as to become 
an immediate source of danger. COa is one of the impurities \ 

54 



DISEASES DUE TO GASES, VAPOURS. ETC 55 






P 



or the air in tunnels and occasionally in coal-mines, but so 
long as there is an adequate quantity of oxygen present at 
the same time respiration can go on pretty well. 

Our knowledge of the harmful effects of COj has been 
largely obtained from Paul Bert, who showed that when the 
atmosphere in which an animal is placed is not renewed it 
dies. The tension of the oxygen falls until it is insufficient 
for the needs of respiration and there occura anoxaimia 
Ibllowed by asphyxia In closed spaces where CO3 Is allowed 
to accumtitate and at the same time sufHcient oxygen is 
introduced, the animals die when the CO3 has become 
xccssivc, owing to the high COa tension in the air jweventing 

.e escape of CO, from the blood. Cartcll ' .ihowcd that the 
heart of a fro^ beating vigorously would cease at the end 
of 10 minutes if plunged into an atmosphere of COz, whereas 
the heart of another frog would go on beating for 1 J hours 
if placed in an atmosphere of pure nitrogen, which is an 
inert gas. Licbeg and Paul fiert have confirmed the harm- 
ful action of CO, upon the muscular fibres of the heart 
During respiration it is not so much the carbonic acid in the 
air breathed that is dangerous, as the COa in the blood 
obtained from the tissues not being allowed to escape. COa 
poisons both the muscular and nervous tissues. 

There are few industrial operations tn which large 
quantities of CO, are given off in a chemically pure form. 
The gas is evolved from vats in breweries during the 
fermentation of beer, and is present in the malt-house, the 
air of which should be renewed before entering. It is formed, 
too, during fermentation in starch works, is met with in paper 
works owing to fermentation of the paste, and in sugar refineries 
during the carbonisation of the juice of beet-root. Years 
ago it was a rr(;i{uent source of accid<:nt and occasionally 
the cause of death of workmen engaged in making wine, from 
fermeatatiort of the grape juice and the cleaning out of 
vine vats. C0« is given off from lime kilns, and is often 
present in unused cellars and in the galleries of mines. 

Carbonic acid calls for attention since it is the gas which 
is present in the air of factories and workshops, and the pcr- 
' " Eitcylopvd. tl Hygitiic," p. S47' 




^ 



DISEASES OP OCCUPATION 




cnvOifB o< wfckli u taken as a. oMMMR gf Oe iaparity of the 
air bfeached bjr the vwken. The Hone Office rcsolatioas 
neqsjre z$o cobic feet of atrao^heric air per individual 
dorlns ordinary wofUng bottra, and 400 dBring overtime, i*, 
btjrond a ten boon' day. Ordinuy atmospheric ur u 
conpOMd of 2093 per cent of oxygen. Tgnot of nitrogen 
witli arKOD, and croj to ono4 of carbonic add, with a small 
quantity of water. The human body b constantly adding to 
ihe amount of COi in the atmosphere of a factory, and when 
there ii also added to this the COj gi%-en off by artificial lights, 
the neeeiBity for the frequent renewal of the air in factoriea 
and workchopx U apparent. A tolerance to COa is created, 
as U aecn in the case of the poorer working classes, aroor^ 
whom there Is overcrowding with little or no ventilation of their 
tlwcllinK-rwrrn. The breathing of an atmosphere vitiated 
by carbonic acid ii a cause of headache and a feeling of 
rnalalHc In thoKc who arc unaccustomed to iL In the case 
of Ihc poorer working classes it cannot but reduce their 
vitaHty and predispose them to disease. Expired air not 
only contains an excess of CO,, it is ladcncd with certain 
volatile rirt^anic products which cause the air to have an 
DfTeoalvc odour. It is this oi^anic material in expired air 
wlikh haa n tlighl RKhicing power upon potassium per- 
MUiiKAtiate, and it regarded by some physioIogt3L<t as the 
|K>lannnua tnnlcrial in the air. Haidanc and Lorrain Smith 
«lii| ttf't find llip inji.H:tlon into animals of large doses of 
water condensed from expired air followed by any bad 
ttflcctJi. but nrown*S<fqu«rd and D'Arsonval ' found that the 
vnlnillc Alkaloid contained in ex[rfred air, and to which they 
.'.ti.- (I>n name of amila^^texim or jMAtruv, was capable of 
the dcHlh uf animals^ It caused the death of 17 oat 
ol I injected under the skin. UTicn the liquid 

ilic lu]\gs dcatli came preceded by tnBam- 
orguUL 
I .- \\\ maintain a standard of purity of the air 

->f In \%^ Sir Henry Ro*coe*s Committee re- 

.1 * standard nf QTolsmcs of CO, per logoooof 



4 



■."Ml 



^riea. Tfab 



co nsid e re d knieat 



I DISEASES DUE TO GASES, VAPOURS, ETC 57 

Hfrom the hygienic point of view. A Departmental Com- 
^■mittee of the Home Ofl^ce subsequently fixed the stAndard 
Hof carbonic 2cid as 12 volumes per 10,000 of air during 
"daylight or where the electric light is u-scd, and where gas or 
oil U u»ed for illuminatiiig purposes the proportion was not 
to exceed 20 per 10.000. The Association of Certifying 
Factory Surgeons, taking 4 volumes of COa as the pro- 
portion in outside air, and 6 as the proportion in in- 
side a.ir, per jo,O00, recomniended that 9 volumes of COa, 
^£f., 5 volumes of CO, per 10,000 in excess of that found 
Bin the outside air, would be a fairer proportion to allow 
during daylight and that double this amount might easily be 
allowed during gas light. From these divergent opinions 
and recommendations it is apparent that a fairly wide and 
reasonable margin must be allowed. It is not desirable on 
the one hand to adopt such a low standard of atmospheric 
purity as to perpetuate a had condition of the air in factories, 
nor on the other hand is it wise to insist upon conditions that 
arc with difficulty obtained by employers. 

Under ordinary circumstances COa is removed from the 
blood during expiration. The presence of the gas in the 
blood stimulates the respiratory centre so that deeper breaths 
are taken and the lungs are better ventilated. It is the 
partial pressure of the COj in the pulmonary alveoli that 
regulates tlie ventilation of the lungs. At normal atmo- 
spheric pressure there is about 6 per cent, of CO, in the air 
spaces of the ]ung». While CO, under ordinary circum- 
stances does not cause any serious symptoms, it is otlierwisc 
tvhen the gas is present in excess and an animal or man is 
breathing the gas in a compressed-air chamber, such as a 
caL^soll. 1 have found when small animab, t^., mice, have 
been exposed for half an hour or longer to 5 atmospheres of 
compres-ted atmospheric air containing i per cent, of CO,, 
that while tlie animals on being taken out of the air chamber 
might appear to be somewhat somnolent and disinclined to 
mo%-c, they shortly afterwards recovered, but that many of 
tbem a few days afterwards, even as long as 10 or 12 days 
afterwards, died unexpectedly, and that the cause of death in 
tome of them was acute inflammation of the lungs. In other 



58 



DISEASES OF OCCUPATION 



instances rats, which seemed to be quite well on bein: 
moved from the caUson, died a few liount afterwards, and 
no naked-eye morbid appearances were presented by thi 
various organs at the autopsy except slight congestion of 
brain, death must have been due to poisoning of the ne: 
centres by CO^ Excess of CO3 in the air is probably more 
dangerous when breathed in the compressed form than 
ordinary pressure. 



I 



Otr^n MonoxifU ; Carbonic Oxide (CO) 

Carbon monoxide, one of the products of the incomplete 
combustion of carburetted gas, also of coal and explosives, is 
met with in subterranean galleries, a^., coal-mines where blast- 
ing has been effected by dynamite or gunpowder. It forms 
7 to 10 per cent of ordinaryilluminating gas and is the source 
of the blue flame seen on the surface of ordinary coal fires. 
The gas is given off in large quantities from coke ovens. It. 
is to the breathing of this gas during sleep that the death 
tramps drawn to the coke ovens by their inviting warmth 
a winter's night is attributed- Carbon monoxide is ffr st ; 
colourless and inodorous gas. It has an affinity for thd 
colouring matter of the blood, varying according to physio-' 
logists from 14010 250 times gre-iter than that of oxygen. 
It forms a remarkably stable compound with the haemoglobin, 
which is with great difficulty dissociated, and to which 
circumstance the extremely poisonou-j properties of the gas 
are due. The presence of such small quantities as o'l pei 
cent, in air is sufficient to cause unpleasant symptoms, such 
as licadache and a sense of tircdneSiS attended with difilculty 
of walking. When the percentage rises to 04 the atmosphere 
becomes dangerous to animal life. ^d 

The gas is evolved from blast furnaces in the smelting o^^ 
iron, the chaining of furnaces and their tapping ; also in the 
manufacture of illuminating gas, the Lcblanc process of soda 
manufacture, in explosions in coal-mines, in cement 
brick works, and in the making of tunnels. 

As we are dealing in these pages with the effects of ; 
poi:5onous gases, it may not be out of place to discuss here Um 
gcacral aspect of the subject from the physiological point 



DISEASES DUE TO GASES, VAPOURS, ETC. 59 

new. The puqxjse of respiration is to carry oxygen into the 
body and to remove waste products from it, mainly carbonic 
add and water. In ordinary respiration the oxygen of the 
Atmospheric air enters into chemical combination with the 
colouring matter, or h.'emoglobin, of the red corpuscles 
of the blood. The oxygen thus absorbed in the lungs 
b quite irrespective of pressure. From these corpuscles as 
they drculate with the blood, oxygen is given up to the 
ti^sues. In addition to the oxygen taken up by the colouring 
matter of the red blood corpuscles, a smaller amount of 
oxygen is also absorbed by the blood in accordance with 
Dalton's law of pressure. The oxygen absorbed by this 
method is so lightly retained that the whole of it will escape 
when the pressure falls below a certain level. Heat also 
favours the dissociation. Carbon monoxide is one of those 
gases which so act upon the bluod corpuscles as to displace, 
volume for volume, the oxygen fixed by the coloured 
corpuscles, and having accomplished this the CO itself is so 
firmly ictaitwd by the hemoglobin as to be displaced only 
with the greatest difficulty. A gas behaving in this manner 
is said to be toxic; it is a poison. The rapid action of 
poisonous gases can be readily understood when there is 
taken into consideration the enormous surface for absorption 
prcscntecj by the lungs, for in the myriads of their capillary 
blood-vessels the blood is brought almost into direct contact 
with the gas. Poisonous gases arc of two kinds, (1) the 
purely toxic, illustrated by carbon monoxide, and (3) irrc- 
spirable gases. Both kinds cause asphyxia. For the 
respiratory functions to be carried on normally it is necessary 
that there »hall be no obstacle to the blood reaching the 
lungs, also when there that it shall be brought into close 
contact with the inspired air. The blood corpuscles them- 
set'ves must be healthy and be present in proper numbers to 
absorb oxygen. Many toxic gases act as a direct poison to 
the red blood corpuscles and unfit them for taking up oxygen ; 
orther gases destroy or irritate the lining membrane of the 
pulmonary alveoli, i.g., the air spaces of the lungs. On the 
other hand a gas like pure hydrogen or nitrogen is irrespir- 
ihle because it contains no oxy^n. 




6o 



DISEASES OF OCCUPATION 



Blast Furttdcts and Carbon Monoxide Gas , 

Several cases of serious illness and a few fatalities hav« 
occurred during the charging of blast furnaces in ironworks 
and in consequence of the escape of crude blast-furnace gu 
from tbe flues. The open-top blast furnaces have been a 
frequent source of minor poisoning to the men who charge 
them, Through the kindness of Dr.C. Stanley Stcavcii*on,of 
Middleton St George, Co. Durham, to whose professional 
care the patients had been entrusted, I had two years ago the 
opportiinityof seeing the cRccts of carbon monoxide poisoning 
upon two blast fumacemen. in these men there were at first 
great sleepiness and headache, followed by incomplete loss of 
power in the limbK, and on the subsidence of the acute symp- 
toms it was observed that speech was affected, much tn the 
same way as in general paralysis. There was a distinct 
articulation defect when I examined the men two or three 
months after the commencement of their illness. The power 
of walking properly had not been regained ; the gatt was 
slow and stepping, the grasp of the hands feeble, and the 
pupils were dilated. There weic nystagmus (a peculiar 
oscillatory condition of the eyeballs) and a degree of nervous 
excitement and exaltation, such as is seen in the worst cases 
of hysteria. One of the patients would burst out in' 
hilarious laughter now and i^ain without the slightesl 
provocation. The simplest questions addressed to him 
scemod to cause amusement Although the genera) physique 
of these men is good, their nervous system has been so 
thoroughly poisoned by the blast-furnace gas that they are 
likely never to do any further work. In conlirmation of this 
statement 1 have recently learned that the mental condition 
of these men remains the same although it is fully two )'ears 
since their illness began. These records are extremely 
interesting, for Uicre have been few cases published of such 
permanent effects having been left by blast-furnace gas> 
That the particular constituent of the blast-furnace gac 
which poisoned these men was carbon monoxide there is 
little doubt when attention is given to the analyses of the 
gas. Analysis of the gas on two occasions from the blast 



^ 

m 




DISEASES DUE TO GASES. VAPOURS, ETC. 6i 

furnace at which the men worked showed the presence of 
Urge quantities of carbon monoxide (CO)i 





A. 


B 


Carbonic acid 


4 


7 


Carbon moDOxtde 


36 


3» 


Hydrogen 


3 


S 


Aracnic 


0.1 


— 


Sulphur 


... trace 


— 


Nitrogen 


. ... 58 


55'3 



In order to make a comparison between the gases given off 
by- the blast furnaces in this particular neighbourhood and 
those from furnaces in another part of the North of England, 
I obtained, through the manager of one of our lai^est iron- 
works, Utc following analysis : 



m 



Carbonic acid 


... 


... 


13-4 


CatboQ monoxide ■■. 


... 


... 


275 


Carburcttcd hydrogen 


... 


... 


0-3 


Hydrogen 


... 


... 


27 


Nitrogen 


... 


... 


57a 



cannot be anything but the high percent!^ of carbon 
monoKide that constitutes the danger in blast-fumacc gas. 
This gas flows away at the end of a slag-tapping, and 
although present at that time in very small proportion, 
1 per cent, it is liable to accumulate in dangerous quantities 
near the furnace boshes, so that isolated workmen ought not 
to be allowed to remain near the boshes when the blow-out 
period of slag-tapping takes place. Blast-furnace gas may 
aeape through a crack in a flue, and penetrating the soil it 
loses its impurities and its odour as it passes onwards. It may 
find its way into inhabited houses and cause the death of the 
inmates. As an illustration of subtle poisoning by carbon 
monoxide gas I need only mention the following: At Pelton 
rdl, a mining village in Co. Durham, some shale which had 
been tipped at the edge of a ravine caught fire. The carbon 
monoxide gas given ofl" during the combustion travelled 
through the soil, and entering two houses in dilTcrent streets 
ftiUy tliirty feet away, caused the death of two elderly people 



63 



DISEASES OF OCCUPATION 



Inhaliition of carbon monoxide causes headache and 
sense of loss of power in the lower extremities. It is 
latter cjtx:unistance which explains many of the cases 
poisoning in confined places. Tlic workman feels that he 
being poisoned, but in attempting, as in a coal-mine, to make 
his way out into purer air his limbs simply refuse to carry him, 
and he falls down in a state of insensibility, poisoned by the 
gas. Death under these circumstances is painless. When 
acute poisoning by sulphuretted hydrogen, for example, 
occurs screaming is heard, as in the case of the men working 
at IIcbbum-on-Tyne, to which in another part of this book 
I have drawn attention. 1 have not seen mention made of 
screaming in connection with carbon monoxide poisoning, 
[t occurred in a young dog which had breathed for only a 
few minutes a high percentage of carbon monoxide gas in 
atmospheric air. The animal at tirst showed a tittle foam 
on its mouth and then uttered two screams. U was at once 
taken out of the chamber in a state of unconsciousness. 
There were slight rigidity of the neck, .spasmodic twitching 
now and then of the hind limbs, and irregular long-drawn 
breaths. By degrees the breathing became regular, and after 
ten minutes' exposure in the fresh air the animal, which 
seemed intoxicated, tried to raise itself, [t was weak in the 
hind limbs and rocked somewhat when attempting to walk. 
Five minutes later it was able to walk without much stagger- 
ing. Within an hour after the development of symptoms 
the animal was running about as if nothing had happeitcd, 
and shortly afterwards no trace of carbon monoxide was, 
spectroscopic examination, found in the blood. 

Many of the deaths that occur in a coal-mine aAcr a fire 
or an explosion arc due to carbon monoxide poisoning. It 
is not a normal constituent of what is ordinarily spolu:n of 
as mine gas, but it is a product of the incomplete combustion 
of coal ; it is found in Che gases from underground fires and 
smoke, and "its percentage increases in proportion as the 
amount of fresh air supplied to tlic 5re decreases. It also 
forms a constituent of the after-damp produced by an 
explosion of fire-damp when the percentage of methane 
exceeds 9*5, because then the proportion of air no longer 







DISEASES DUE TO GASES, VAPOURS, ETC. 63 

nffices for the complete combustion o( the methane " (Otto 
Bninclc). Fortunately verj* small quantities of carbon mon- 
oxide do not cause immidiaU poisoning. Miners who have 
had experience of the gas and nf the headache caused by 
breathing it can, if their limbs will carr)- them, usually make 
their way out of the place where the gas Is present. 



SjnHftomaiQhgy of Carhon Mon<fxide Poisoning 

Giddiness, headache, throbbing of the temples, and ringing 
in the cars, accompanied by a sense of tiredness, are the 
symptoms usually experienced by persons who have been 
cxpoecc] to carbon monoxide gas. In severe cases there may 
be convulsions and I0&9 of consciousness. When the gas 
enters a bedroom and is inhaled by persons who are asleep, 
the sleep only becomes deeper; a profound narcosis is 
developed from which, in many instances, there is no 
iwaking. Should perchance the accident be discovered early, 
and the persons treated, there arc occasionally observed on 
recovery inability to swallow and muscular tremor. The 
patient awakes as if from deep sleep ; he is dazed for a time 
vaA does not recognise his surroundings. He may bring up 
a little bIood>staincd mucus from his bronchial tubes. One 
of the most important aftcr-efTects i^ an alteration or a loss 
of speech. 

Pathology of Carbon Monoxide Poisoning 

When death has occurred the face of tlie cadaver may be 
pale, livid, or rosy-looking as in health. The face wears a 
calm expression, showing that no suffering had been ex[x;ri< 
enoed. The pupiU are dilated. If the body is examined 
shortly after death, the blood has a beautiful cherry-red 
colour. Small hj^monrhayes may be found in the skin, 
causclcs, lung!4, brain, and mucous membrane of the stomach, 
On spectroscopic examination the blood exhibits two distinct 
bands between D and E, the yellow and the green lines. 
aimiJar but not identical to those given by oxyha;moglobin, 
the normal colouring matter of the blood. The blood in 



-d 



64 



DISEASES OF OCCUPATION 



carbon monoxide poisoning diflers from that in health in 
far as it cannot be reduced by such a reagent as ammontui 
sulphide or Stokc-s' fluid,' and it is upon this circumstan* 
that the spectroscopic test of blood in carbon monoxide rest 
The gas forms such a stable compound with the colourit 
matter of the red corpuscles of the blood that it is difficult to 
subtract the oxygen fronn it, hence the occurrence of death 
by asphyxia in these cases. Although there is neither 
immediate irritation of the lungs caused by the inhalation of 
carbon monoxide nor marked difficulty of breathing, yet a 
few days after an apparent recovery death may come pre- 
ceded by signs of acute congestion of the lungs. At the 
time the tendency, rather, is for the higher cerebral centres to 
become benumbed and for sleep to follow. On microscopical 
examination of the brain and medulla in fatal cases minute 
haemorrhages are frequently found. 



Can Carbon Monoxidt PmdraU into tht Dh<fd of a C* 

An interesting paper bas been published by Strassman 
Schultz," raising the questions as to whether the detection ol 
carbon monoxide in the blood proves unmistalcably that 
poisoning by the gas had occurred, or whcUier death might 
not have been due to other causes, and that, since the corpse had 
been placed in an atmosphere containing carbon monoxide, 
there had not been absorbed a sufficient quantity of the gas 
to complicate the diagnasLs of suicidal or accidental poisoning 
or death from some other cause. When carbon monoxide is 
found in the blood the natural inference is that it wa« inhaled 
into the lungs during life and in this way entered the drcnla- 
tion. In 1902 Wachholz and Lenberger immersed 
bodies of stillborn children in an atmosphere of pu 
carbon monoxide gas, and in half an hour the deep livid 
patches obiser\'cd in the skin of the cadavera had become of 
a red rose colour, and tn the blood the presence of carbon 

' Slokn' fluid Riusl bo (rcshly r^feporcd wlicn required, 
solution of (erroui MilphAt« to which a little tartaric acid is 
then Mnmonia till Ihc reaction is allnilinc. 

' Bethn. KUn. Wiscktns., 1904, No. 48. 




]la- 

lun^^ 

ivid ] 



01 caruoi i I 

9d. It bfl 

; added utTl 



DISEASES DUE TO GASES, VAPOURS, ETC. 65 



I 



I 



» 



mODOxide was determined by the spectroscope — not only 
tbco, but as late as seven days afterwards, in the blood 
removed from the heart. The longer the time that had 
elapsed between death and placing the cadaver in the gas 
Ibc less likely was carbon monoxide to be absorbed. Strasti- 
man and Schuh?. are of the opinion that carbon monoxide can 
penetrate into the blood of a dead person through the skin 
and external coverings, and that the amount of carbon 
monoxide in the superficial and more exposed blood and 
tissues is always greater than that found in the deeper and 
more central parts. 

It is oertatnly desirable that an answer should be returned 
to the question as to whether when carbon monoxide is pre- 
sent in the blood of a dead person the gas has penetrated 
durirtg life or after dcnth. Mirto maintains that in the 
diffusion of the gas post mortem there is a distinct dificfcnce 
between the anterior portion of the liver, which is rich In 
carbon monoxide, and the posterior portion, which is of a 
deeper ctdour and contains less of the gas. It is stated that 
this diflcrcnce is not observed when death has come by 
pmsoning. The blood in the deeper parts of the body con- 
tains less carbon monoxide than the vesscl-i at the periphery. 
Strassman and Schultz found in their experiments upon the 
corpses of old men that there was no part of the body, 
practically speaking, into which carbon monoxide dtd not 
penetrate, provided there was a sufficient length of exposure 
to the gas. These obscnicrs loo. also noticed the diflTerence 
between the anterior and posterior portions of the liver to 
which| Mirto had drawn attention, also that in cutting 
through the tissues the blood neatest the skin always con- 
tained the greater amount of carbon monoxide. Such a dif- 
ference would not occur in a case of poisoning by inhalation of 
carbon monoxide, since the blood would be equally affected 
all through the body. The weak point in Strassman and 
Schultz's experiments is that they do not state what the 
quantity of cartx>n monoxide found in the blood was. The 
ifflportancc of this remark is at once apparent when it is 
known that very minute quantities of carbon monoxide may 
be present in the blood in normal conditions. The possi- 

Y 



66 



DISEASES OF OCCUPATION 



bility of the diffusion of carbon monoxide into the blood and 
tissues of a corpse is a matter of great importance from a 
mcdico-lcgal point of v\cw, as the following case shows. In 
Berlin (Feb., 1904) a woman was found dead in her room \ 
with one end of an indiambbcr pipe in her mouth and the 
other attached to a gas pipe, the valve of which was open. 
The room smelt strongly of coal-gas. Everything seemed to 
favour the theory that death was suicidal, tiut at the last 
moment the father of the dead person intervened and asked 
for a delay in the interment, as he bclies'cd an operation for 
the induction of abortion had taken place at the instigation of 
the husband, and that in order to raise the question of liuicidc 
the tube had, in order to mislead, been placed in the woman's 
mouth. An inquiry was ordered, and Strassman and Schuttz 
found that no abortion had taken place, and that there were 
all the typical si^s of poisoning by carbon monoxide on the 
lines stated in the earlier paragraphs of this article. J 

The bodies of persons poisoned by carbon monoxide' 
retain their colour and frequently resist decomposition 
longer than under ordinary circumstances. This has been 
obiiervcd in some coal mining disasters, so that when the dead 
bodies are brought to the surface the comrades of the dead 
men, under the impression that death had recently taken 
place, are not slow to state that the men might have been 
saved had the rescue work been more timely. Knowledge 
of the prcscrvativx power of carbon monoxide upon tbe 
tissues ts taken advantage of by butchers abroad to preserye 
meat by killing the animal by means of carbon monoxide, 
or after dc5tro>ing the animal by cuttii^ up the flesh and 
exposing it to an atmosphere containing carbon monoxide and 
sulphuric acid \-apour (" Les Empoison nements," Krouardd, 
p. 383). The meat thus treated docs not putrefy, but it 
WKlcr^oet a peculiar decomposition and becomes black and 
anvholesome. All such methods of treating batcher ooeat 
•ic to be dcploccd and should be iaierdicted. 

Can living bodies becocoe accusliMned to carbon moa- 
(ucide? This is * subject which Nasmith and GrahuB* 

I and s. 



DISEASES DUE TO GASES, VAPOURS, ETC. 67 

have tried to solve by means of experiments. Carbon 
BKmoxidc, as already stated, causes death by destroying 
tbe oxygen-carrying j>ower of the blood. Nasmith and 
Graham allowed guinea-pigs to inhale carbon monoxide until 
there occurred a 2$ per cent saturation of the colouring 
■natter of their blood with the g&s. The animals received 
daily for several weeks carbon monoxide. None of the 
animals decreased in weight — 00 the contrary, most of them 
gained; and although they were living with 25 per cent, of 
their ha:mog1obin saturated with carbon monoxide they were 
JQSt as happy and active as those living in ordinary atmo< 
spheric air. As these animals were living with only three- 
quarters of their harmogiobin available for oxygen-carrying 
porposes, it was thought they would suffer in health and 
ihat ansmia would follow ; but instead of this occurring, the 
red blood celts increased in number, just as in people who 
live .It very high altitudes, and as if a proliferation of new 
cells had taken place to com^wnsatc for the degeneration 
of some of the red corpuscles. "With 25 per cent, of its 
blood rendered useless for oxygen-carrying purposes by 
its union with carbon monoxide the guinea-pig h capable 
of compensating and will manufacture new red blood cor* 
puscles until it has reached a total of about 8,000,000 with 
a corresponding haemoglobin of los per cent." The normal 
number of red blood cells in the peripheral circulation of 
guinea-pigs is about 6,000,000 per cmm. of blood, with 88 per 
cent. HaMnoglobin. The animal with true compensation has 
still three-fourths of its blood corpuscles and three-fourths of 
its hxraogtebrn available for carrying oxygen. To counteract 
the effect of carbon monoxide a guinea-pig will manufacture 
3^000,000 additional blood corpuscles per cram, in from three 
to four weeks, and Uiis Increase continues for several weeks 
after the animal is placed in the open air. Nasmith and 
Graham carried their experiments further so as to produce 
35 and 45 per cent saturation of the haimoglobin. " The 
eflect of depriving an animal of the use of part of its 
hiemoglobin by allowing it to unite with CO is also in 
many respects similar to depriving it of part of its blood 
hy bleeding," We have seen that the effect of chronic CO 




68 



DISEASES OF OCCUPATION 



poisoning is similar to that wKich occurs at high altitudes 
The similarity is explained by the lack of oxygen being 
the chief cause of tlic charges in the blood. When a normal 
animal wa» put in an atmosphere sufficient to cause 45 per 
cent, haemoglobin saturation it would die in three to four days, 
while the acclimatised animals remained in good health. 
In addition to the red the white corpuscles of the hiood 
are increased as well. There is therefore a leucocytosis 
called forth in the guinea-pig by saturating the blood with 
the gas. Lack of oxygen produces an auto- intoxication. 
Carbon monoxide poisOTing is nothing else than a toxasmia 
caused by lack of oxygen. When the colouring matter of 
the blood i.<t saturated with CO it cannot take up oxygen. 
In proportion as CO-h3em<^lobin is formed so does the 
blood lose its power of giving up oxygen to the tissues 
and death therefore ensues. The CO tends to drive out the 
oxygen from Ihe hrL-moglobin and the "final result 13 an 
expression of the balance struck between the two conflicting 
processes." llaldane has shown that when a person remains 
exposed to a moderate percentage of CO the blood ceases 
after a time to take up more CO. In the case of the living 
body it is roughly estimated that "with about xtS per cent, 
of CO in the air the harnioglobin will 5nally become about 
half saturated with CO while with *04 per cent, it will 
become a third saturated, and with 'iG per cent two-thirds 
saturated."* Men, like animals, can within limits become 
acclimatbcd to CO ; and since after a time the blood ceases 
to take up more CO, it is a question whether men who 
in their occupation might unexpectedly be called upon to 
inhale CO should not train themselves to this acclimatisa> 
tion and bring about that compensation in the blood which 
we have seen occurs in the guinea-pig. Its effects are the 
same as living at high altitudes and it docs not appear 
to be attended by any inconvenience. By gradual habitua- 
tion I have been able to expose dogs to 08 per cent of CO 
in compressed air for several hours without any bad eficcu. 
Probably man could be similarly trained. 



• II 



Th« lavestigalSon of Mine Air," Haldane. p. 145. 



DISEASES DUE TO GASES, VAPOURS, ETC. 69 



I 



Ferrd'SilitoH 

Owing to the death of four persons on a Swedish ship 
which had been carrying a eargo of ferro-silicon, attention 
has been drawn by Professor Cronquist to t!ic dangers 
incidental to the transport of this material. The inquiry 
showed that poisonous gases are given off by fcrro-silicon. 
During the last few years high-grade ferro-silicon has been 
produced on a lai^e scale. While in ordinary pig>iron there 
may be only 2 to 3 per cent, of silicon, in the softer forms 
of pig-iron there may be as much as 1 j per cent, of tlits 
material. The presence of silicon lends to reduce the 
amount of carbon that molten iron can absorb, and to 
favour the decomposition of any combination which carbon 
may have effected with iron. In iron ore and quartz there 
is frequently present a large amount of phosphate which in 
presence of carbon and a high temperature forms phosphide, 
e^., calcium phosphide if calcium is present. If arsenic 
is also contained in the ore, calcium arsenide might in 
addition be formed. When ferro-silicon is brought into 
contact with moisture phosphurettcd and arseniuretted 
hydrt^n gases arc evolved, both of which are powerful 
poisons and capable of causing serious .lymptoms when 
inhaled. In addition to these poisonous gases, explosions 
have occurred on board ship the cause of which has not 
yet been absolutely determined. The dangers incidental 
to the transport of fcrro-silicon arc not alone to the per- 
sons on the ship, but also to the dock labourers employed 
in unloading the vessel. Since moisture is the cause of 
poisoning, owing to the liberation of gases, the greatest care 
should be exercised so as to prevent the entrance of moisture 
into the receptacles which contain fcrro- silicon. 



lUuminating Gas : Water Gas 

7*hc risks to life and danger to health from coal gas as an 
iUuminant, also from water gas, dejKiid less upon their 
manufacture than upon the uses to which these gases are 
put. Although composed mainly of hydrogen and car- 




70 



DISEASES OF OCCUPATION 



burettcd hydrogen, coal-gas contains as much as 7 to lo per 
cent, of carbon monoxide. It is to this ingredient that the 
illuminant owes its poisonous character. Owing to its dis- 
agreeable odour coal-gas can be readily detected, but should 
it escape from a pipe outside a house or factory and make 
its way into a living-room or into a workroom, the gas in 
passing throueh the 5oil loses its odour but still retains the 
poisonous carbon monoxide. People may thus unknowingly 
be breathing a poisoned atmosphere. When a fracture of a 
large gaspipc in a roadway has occurred and coal-gas has 
been escaping for some time, the soil for a considerable 
distance around may become so impregnated with the gas 
that, apart from the risk of explosion through men working 
at the spot with naked lights, the labourers who overturn 
the soil may be so overcome by the gas that they become 
unconscious, or they experience severe headache and suffer 
from vomiting and giddiness so that they arc obliged to 
retire and seek purer air. I have known workmen who had 
been thus employed suffer in tlicir nervous system for weeks 
after exposure to the ga-s and in one instance I attributed a 
tem[>orary glycosuria in a workman to this cause. Eleven 
parts of coal-gas per too of ordinary air form an explosive 
mixture. The mixture is still explosive up to 30 per cent, 
but ceases to be 30 after 60 per cent. 

iValer gas, which is obtained by passing steam over 
red-hot coke, is occasionally added to ordinary coal gas to 
improve its illuminating properties, and since carbon 
monoxide is frequently present in water gas to the extent 
of 30 per cent, this addition of carburetted water gas 
increases considerably the dangers of the ordinary illu- 
minant. Water gas, although much more dangerous, has 
not the disagreeable odour of ordinary coal gas. Its escape, 
therefore, into a living-room or factory is less likely to be 
perceived. In a memorandum issued by the Chief Inspector 
of Factories, dated September, 1904, which deals with the 
use of water gas and other gases in factories, attention is 
directed to the manufacture and distribution for heating and 
lighting purposes of any poisonous gas that does not contain 
a distinct and pungent smelL It is recommended that in llie 



I 







DISEASES DUE TO GASES, VAPOURS, ETC. 71 

manufactun: of Mond gas, not only should the quantity of 
cart»n monoxide in the gtis be lim ted to 14 per cent, but 
thai the gas should be strongly scented, so that its presence 
may be readily detected. The importance of this recom- 
mendation is apparent when it is stated that between the 
years 1899 and 1903 there were reported to the Home Office 
5 1 cases of poisoning from carbon monoxide gas (including 
1 7 deaths) in manufacturing premises traceable to leakages 
froai pipes conveying gas, and the cleaning of tanks or flues 
before sufficient time bad been allowed for the gas to 
become dispersed. It is a regulation of the Home Office 
that printed bills, calling the attention of the workpeople 
to the deadly nature of the gas and the best means of 
rendering first aid, shall be posted on the walls, also that 
persons with a diseased heart or lungs should not be allowed 
to be in charge of an engine worked by gas, that the valves 
and connections of engines should be frequently examined 
for leakages, and that all flues should be well flushed out by 
fresh air before the men enter them. Men employed in 
factories should have a training in ambulance work, su that 
should an occasion arise when some of their comrades have 
become overpowered by the gas, they may at once be 
capable of resorting to artificial respiration and of following 
this up with oxygen inhalation from cylinders of compressed 
oxygen, which ought always to be at hand. 

1 have alluded to some of the permanent effects produced 
upon the central ners'ous system by the inhalation of coal gas, 
Jt is not so widely known as it ought to be that peculiar mental 
conditions may be a consequence of coal-gas asphyxiation. 
Dr. Sanger Brown, of Chic^o,* draws attention to this 
subject The patient a male, had been found in a sitting 
posture, leaning against a wall near a gas stove, from 
which gas was freely escaping. He was unconscious, but 
by means of artificial respiration and inhalation of oxygen 
be regained consciousness three days afterwards, and in 
three weeks he was able to be up and about His pulse 
remained high — 140 per minute — and there was difficulty of 

' fournai 0/ IMe dmerican Uaiicat Association, Cbicaj^o, April 38, 
1906. 



breathing on the slightest exertion. The patient's expression 
was dull and stolid. The red blood cells numbered 5,224^00 
per cmm., and the ha:mogIobin. or colouring matter of the 
blood, was 80 |>er cent The time, from thirty-six to fortj-- 
cight hours, before he was discovered was a complete blank 
to him. Memory for recent events was practically anni- 
hilated, although he could repeat incidents of his childhood 
well and discuss with friends events immediately previous 
to his asphyxiation. He would read the newspaper, but 
could not discuss current topics. The mental condition 
never having improved, he died suddenly, eight months after 
exposure to the ^s. At the autopsy no gross changes \fere 
found in the brain or spinal cord, nor was there anything 
present in the other organs beyond slight dilatation of the 
heart to explain the sudden death. It is more than probable 
that some physical change had occurred in the brain cells of 
this patient, whereby they were no longer able to retain new 
impressions in the same way as previous to the accident. In 
a similar manner, in alt probability, had the nerve cells which 
control the beat of the heart become alTected. 

Grcidcnbcrg ' reports three cases, one of which terminated 
fatally. In the other two patients, a male and female, 
recovery was slow. There were loss of memory, interference 
with the power of speech, inconlinence of urine and fa^cs in 
the male, and subsequently dementia. Other obscn-crs have 
reported cases in which, after recovery from the acute symp- 
toms, there were headache, pains in the limbs, weakness of 
memory, staggering gait, incontinence of urine, exaggeratedj 
knee jerks, tremor of muscles, and death from bronch( 
pneumoniu. In the ner\'ous system there have been found 
small hicmorrhagcs in the brain and spinal cord, patchy^ 
softening of the spinal cord, blocking of the small blood- 
vessels in the optic thalamus, fatty degeneration of the 
endothelial lining of the small blood-vessels of the centralj 
nervous system, chromolytic and atrophic changes in tht 
large motor nerve cells, and thickening of the pia mater 
covering the brain. 



" Uvbcr Psychoscn n. Kohloiraxydgss," Vralsch (Russian), 1898. 




DISEASES DUE TO GASES, VAPOURS, ETC. 73 



In the manufacture of nickel carbonyl from nickel copper 
oxide workmen have died in such a rapid manner and under 
such unexpected circumstances that the Home Ofiicc and 
foctory owners felt themselves called upon to make a careful 
inquiry into all the attendant circumstances. Nickel carbonyl 
is made in air-tight closed iron chambers. The deaths that 
occurred «-erc in some instances almost instantaneous, while 
in others the men died a few days afterwards from in- 
flammation of the lungs. Nickel carbonyl is a very volatile 
liquid: it boils at 43"'C (l09'4''F.). It is obtained from 
finely divided nickel oxide by first passing; hydrc^cn gas 
over it. After the water has been removed from the nickel 
cocnpoond, carbon monoxide is brought into contact with 
the residue; the resulting product is nickel carbonyl. 

In the case of one man who dit^d after three days' illness 
the lungs were found to be o^dcmatous and intensely con- 
gested ; in another the lungs were iiiHamcd and consolidated 
as £d pneumonia. In the minor forms of iJoisoningf, the men 
complain of giddiness, difHculty of breathing, vomiting, and 
unsteadiness in their gait Opinions are divided as to the 
uusc of sudden death and the iU'health of the workmen, but 
as there have usually been found small quantities of carbon 
monoxide gas in the immediate vicinity of where the men had 
been working, due to an accidental escape of the gas from a 
leak In the machinery, the symptoms have been rt^^rdcd as the 
result of CO poisoning. In a nickel carbonyl worker who died 
eight days after the commencement of his illness, numerous 
hemorrhages were found in the brain and cerebellum, and 
the nerve cells of the respiratory nucleus in the medulla 
oblongata showed distinct chromolytic changes. A rabbit 
which had breathed on two occasions an atmosphere 
impr^nated with the gas given off by 10-15 drops of 
nickel carbonyl, and which seemed well on removal from 
the bell jar, was found dead in its hutch a few days after- 
wards. I »ent the brain to Dr. Mott, Laboratory of the 
Metropolitan Asylums Hoard, to whom and to his committee 
I am indebted for a microscopical examination of the same. 



74 



DISEASES OF OCCUPATION 



Numerous small hxaiorrhagct were found in the brain 
medulla, with acute chromolytic changes of the cells in tt 
medulla oblongata.' The lesions found in the body after 
death from nickel catbonyl poisoning are the same as those 
found in carbon monoxide poisoning, and as lOO cc of 
nickel carbonyl give off 7*3 litres of carbon monoxide 
this circumstance and the fact that in the case of nick 
carbonyl workers who have become ill there have alway 
been found small quantities of CO in the factory close 
where the men had been working, at Brst sight suggest t\ 
the cause of poisoning in these cases is carbon monoxide. 
It is doubtful as to whether after all CO is the toxic a^ 
in Ni(C0)4 poLsoning. Langlois found on shaking 
blood with Ni(C0)4 that the ox>'gcn of the hacmc^lobin was 
replaced by nickel carbonyl, and Vahleen showed that when 
circulating in the blood vessels Ni(CO)4 split up into CO and 
nickel, and he concluded that Ni was Uic cause of death. 
H. W. Armit" after a series of carefully conducted experi- 
ments is also of opinion that the poisonous effects of Xt(C( 
arc due to nickel and not carbon monoxide 

Fern Cctrh&Hyi, 

or iron carbonyl, a light sherry -coloured liquid, is, 
nickel carbonyl, extremely volatile and equally pois 
A rabbit exposed for fifteen minutes to the vapour pn 
ofT by ten drops of the 6uid, although at the time apparent 
nothing the worse for the inhalation, was found dead in 
hutch on the following day. The lungs showed intec 
congestion, with rupture of several of the pulmc 
capillaries and escape of blood into the air-cells. 



Sulphurettfd Uydrogtn Gas (/TjS) 

This gas when breathed is extremely dcstractive 
animal life. It causes death almost instantaneously 
inhaled in large quantities. In the Laneet, January 24, 19OJ, 

' Sec ray Ha.rben l^ctura, Royiil Iniititulc ['uKlic ficalih, 1905; 
aSfoAnktva of ti£itntagy,'vol.'uu, 1907,}!. 258, paper by Ur. F. Wtj 
• ymirnal of Hygitite, July, 1907. 



DISEASES DUE TO GASES. VAPOURS, ETC. 75 

I reported the death of four workmen caused by the inhalation 
of UjS. Upon two of the bodies I made a post-tnnrtcm 
cxatnination. The findings at the autojwy were, practically 
speaking, nil. Beyond a dark and fluid cundition of the 
blood and slight a-dcma of the lungs, nothing distinctive was 
ibinid. The men had been employed in making excavations 
for a dock on the banks of the River Tync, close to some old 
refuse from a chemical works, itnd from this refuse there was 
a constant trickling of water rich in HjS. The water had 
made il» way into the iron cylinder in which the men were 
irorking. One huiidrixl volumes of the water on being boiled 
gave ofT I3'2 volumes of HaS. 

Three of the men lost their lives in an inaedibly short 
time. One of the workmen had got into the iron cylinder, 
and shortly afterwards, a cry having been heard, a comrade 
ran to his rescue, and after entering the open caisson be 
too gave a cry. This brought a third workman to the 
cylinder, and on his attempting to reach the men he too was 
overpowered by the gas, and fell dead upon the lifeless bodies 
of his mates. 

Struck by the rapid death of these men by inhaling H3S 
gas, I determined to ascertain in what proportion the 
pre»enc« of sulphuretted hydrogen in atmospheric air became 
poisonous. In submitting a healthy dog to an atmosphere 
containing 002 per cent, of H»S, no effect followed, nor did 
anything h;»[>{>cn until the quantity of IT,S rose to 0"IS per 
cent, when the animal suddenly became rigid and fell 
apparently lifeless, its breathing having ceased. On removing 
the animal, a feeble beat of the heart could now and then be 
beard through the stethoscope. Uy means of artificial 
respiration the animal in 2} minutes was quite itself again. 
The action of H3S is extremely rapid. A few seconds after 
exposure to an atmosphere containing even a small per- 
centage of HaS, it is noticed both in men and animals that 
the respiration becomes somewhat gasping, and almost 
inoKdiately afterwards, without further warning than the 
utterance of a cry, the individual falls down dead in a state 
of extreme rigidity or in a condition of suspended 
respiration. 



76 



DISEASES OF OCCUPATION 



Sulphyrcttcd hydrogen gas causes death by its action u[ 
the R'^pinttory centre. There is no warning; dc;tth is sudt 
and painless. Occasionally a scream is uttered, but by 
time the poisoned workman is reached death has taken p!j 
or the breathing has ceased, and only a faint and intermittent 
beat of the heart can be heard, for it cannot always be felt 
After death no characteristic lesion is found in the body to 
explain the fatal result from HjS. Along with Dr. R. A. 
Bolan I exposed blood serum to the vapour of HaS, and we 
found that the colouring matter, or hemoglobin, was slowly 
convened into metliitmoglobin, but to obtain this there is 
required an exposure of several minutes. Death takes place 
with such rapidity in HaS gas poisoning that to this cJrcom- 
stance must be attributed Uie absence of mcthsmoglobin 
from the blood of men who have been suddenly overpowered 
by the gas, 

HaS is the cause of the sudden death of workmen 
employed in the sewers of large cities. The danger is most 
likely to occur when the sewers have become blocked. The 
presence of o'2 to o"4 per cent of H,S in the air is 
extremely dangerous to men working in sewers. Other 
poisonous gases than HgS are frequently met with in scv 
such as carbon monoxide from the escape of coal-f 
carbonic acid, ammonium sulphide, &c. 

The rapidly fatal action of HjS is due to the effects of 
gas cither upon the respiratory centre or upon the tcrmir 
endings of the pneumogaslric nerves in the lungs. IJet 
thought that poisoning by H3S was due to the formation 
sulphide of iron in the blood by the abstraction of iron fr 
the colouring matter of the red corpuscles, but if this 
place at all it can only be in those extremely slow forms 
poisoning where death comes by coma, for death, as a 
comes too suddenly for such a possibility to occur. 

Since HjS is one of the products formed during the putre" 
faction of oi^anic matter containing sulphur, the gas is found 
in privies, the mud of marshes^ and in collections of 61th 
manure. There are only a few industrial undertaking<i in which 
HaS may be met with, .such as chemical and gas works, the 
black bronzing of metals by means of sulphide of arsenic. 




DISEASES DUE TO GASES, VAPOURS, ETC. 77 

cleaning out of boilers, in certain processes of soap- 
wberc large quantities of fat are decomposed, and in 
preparation of Prussian blue during the decomposition of 
ferro-cyanide of potassium by sulphate of iron. 

Tbc xymptoms met with in the minor forms of industrial 
sulphuretted hydrogen g.is poiMjning are nausea, vertiRO, 
headache, and general malaise, all of which soon disappear if 
the nrorkman goes into the open air. In poisoning by HgS 
the workman should be brought at once into the fresh air and 
artificial respiration immediately resorted to. and continued 
until perhaps a cylinder of compressed oxj^cn can be 
obtained. 



Bisulphide of Carbon (CSa) 

This colourless volatile li()uid with a disagreeable and 
repellent odour is used in the manufacture of waterproof 
goods and in the vulcanisation of indiarubber, owing to the 
rapidity with which it parts with its sulphur. It is an active 

id penetrating solvent. 1 1 is the vulcanisation, or " curing," of 
iarubber goods that is the dangerous process in an india- 
rabber works. Vulcanisation of indiarubber goods enables 
tbon to withstand alterations of temperature and exposure 
to the weather. Owing to the inHammability of CSi, the 
work has to be carried on in rooms in which there arc no fires 
and no naked lights. 

Tbc vapour given off by CS3 has not only a most un- 
pkasact odour, it is dangerous when inhaled. It causes 
beadache, vomiting, and vertigo. These symptoms, if only 
li^hl, will disappear if the worker goes into the freuih air. 
In the deeper forms of poisoning more serious ^mptoms 
are observed, e^.. staggering when walking as if the indi- 
vidual were intoxicated,a sense of extreme tiredness, and loss 
of appetite. When acting as medical expert on the 
Dangerous Trades Committee of the Home Office, I visited 
Krcral of the large indiarubber manufactories of England, 
tad found that there had been a considerable amount of 
sickness and ill-health among the men and women employed 
in tbo£e departments where CSa had been made use of 



78 



DISEASES OF OCCUPATION 



Some of the men whom I saw had been off work 
months, and tt-ere just recovering from paralysis of the ai 
and legs due to peripheral neuritis. On young wc 
whose work consisted in dipping such small goods 
children's balloons, tobacco pouches, toys, &c.. into a bath 
bisulphide of carbon the vapour had peculiar cffe 
Occasionally on their way home at nights from the facte 
the girls would stagger and fall, and on reaching home wouf 
sit down by the fire ami fall asleep without touching fo 
Next day they would feci shaky and tremulous, like men 
after a debauch, and they would only recover their steadiness 
after they had again inhaled for a little the vapour from the 
carbon bisulphide. In other instances the CS3 would cause 
acute hysterical symptoms. A worker would become talka- 
tive, irritable, excited, and the subject of causeless outbursts 
of laughter. Acute delirium may occur, attended with 
delusions. In the more chronic form of poisoning there 
have boKH observed weakening of the memory. dtfRculty of 
Speech, loss of muscular jjower and of sensation in the anus 
and legs. Women, if pregnant, frequently miscarry. Occa- 
sionally there occurs amblyopta, or loss of vision. 

G. Hauft,' having met with two cases of accidental 
poisoning by carbon bisulphide in men, tried the effects of the 
vapour uj>on animaU. There were the usual symptoms cf 
excitation followed by paralysis, and at the autopsies 
liver cells were found sometimes healthy, at other timi 
diseased, the kidneys the seat of an interstitial nephritis, ar 
the lungs the seat of a pneumonia. The central nervoi 
system failed to show any naked-eye appearances to explai 
the progressive paralysis, which, commencing in the cxtre 
tics, subsequently invoK-ed the muscles of respiration, ar 
finally the heart. There is a general opinion that C! 
converts the colouring matter of the blood into hiemoglobii 
but, on the contrary, A. Chassevant maintains that it 
the power of transforming mctha;moglobin into ha^moglolnn^ 

Improved ventilation of the workrooms and the adoption 
of means to draw the vapours do^vnwards and away from the 
workpeople have done much to diminish the number 
■ Artliipc iHltmat. di PhanHoccdynamie, 1903, t. xi. p. 155. 



DISEASES DUE TO GASES, VAPOURS, ETC. 79 



of bisulphide of carbon poisoning in tndiarubber 
works ; but as CS» is a dangerous and a subtle poison the 
boors of work should not be too long at a stretch, and it 
would t>e well {f employers could alternnte from time to time 
ttc occupation of the workers. 

^H Acetykne Gas 

Acetylene gas is formed when calcium carbide (CaCa) Is 
brought into contact with water. The gas has illuminating 
properties superior to those of ordinary gas, and as It can 
be readily prepared it has come to be sought after as an 
iltatninant for country houses. When purified from calcium 
sulphide and phosphate the ethereal odour of the gas is not 
onpleasant. Small quantities of acetylene can be inhaled 
without any bad eCTects. When the gas is present in the 
itmosphcrc of a room to the extent of 40 per cent, by 
vollUDC, it is capable of causing death, but n'hen inhaled in 
tbe open air it produces little harm, since the poisonous 
sction of acetylene is feeble so long as the blood is at the 
same time supplied with air containing a proper amount of 
oxygen. Brociner' found that 100 volumes of blood dts- 
solved So volumes of acetyleite. The blood showed no 
characteristic spectrum, and, like normal blood, it was readily 
reduced by ammonium sulphide. Professor Mosso, of Turin, 
and his assistant Ottolenghi in their experiments found that 
Ketylcnc was toxic to dogs and guinea-pigs, and that air 
nixed with 20 per cent proved fatal within half an hour, but 
that when the symptoms developed the animal would recover 
if taken into the oi)cn air. In my own experiments upon 
rabbits I found that so long as ordinary atmospheric air was 
fteely supplied along with acetylene no symptoms developed, 
bat when ordinary air was excluded or a very high per- 
centage of acetylene was present, symptoms gradually de- 
veloped. ■ Symptoms of poisoning by acetylene are more 
slowly induced than in ordinary coaUgas poisoning. An 
animal on becoming intoxicated would fall on its side, 8p* 

■ Boiton lAtd. and Surg, foumal. July 30, 1S96. 
• Brilisii Mtdkal Journal, April 2\, iii^ 




So DISEASES OF OCCUPATION 

parently Jn a profound sleep which woultl pass into coma, 
even to this condicicMi a (ck breaths of fresh air were suffict 
to restore it. If the inhalation of acetylene gas wvre pushed 
signs of asphyxia vrould show thcmseU-es. and the animai 
wouM become at Brst temporarily cyanoscd and subsequently 
pole. In the deeper stages of acct>-Ienc poisoning tttc blood- 
vesseU arc extrvmcly contracted, so that it is difficult to 
obtain a fev drops of blood frotn them for examinatloi^^ 
Once the stage of asphyxia has been reached recovery ^H 
more difficult, and yet the blood on spectroscopic exaixiina~ 
tion shows the two tveU-marked and characteristic bands of 
oxyharmoglobin and on the addition of ammonium sulphide 
and heat is readily reduced. Instead of entering, like carboo. 
raoaoxtde, into chemical combination with the colouring 
matter of the red coqwsclcs of the blood, acetylene [5 
probably dissuK'ed in the liquid part of the blood, hence the 
fact of its being less harmful than coaJ-gas, and of its 
so mocfa less paisonous than water<ga5. 

When persons arc overoome by acet>'Icnc gas they 
be taken at once into the open air and artificiai respi. 
resorted to if necessary. Oxygen should be administered 
the patient is recovering Silowly, the limbs should be 
rubbed and the extremities kept warm. .A hypoder 
injection of a minute dose of str>'Chnine may be 
or an in}ectian of strong hot co f fee l^ the rectum. 



Qaxify dwyiug S^i er Im/UmmMr PainiT 

Several cases have been reported of men 
unconscious when working with quickly drying paints, 1 
of men becomii^ seriously boTucd as the result of 
accidental firing of tfae vapour given off by tbc pnints. 
iotrodoction of rapidly di^-ing or spirit paints ts of 
tlale and is an illustration of the tindne haste and 
oT nodera times,. Wbca a ship pvts into port for 
days the vessel can be docked and painted inside and 
ontaMe to tbe extent nquind and be able lo leave the dock 
again in less than cvd days owing to tfae use of 
di}~tpg paints^ Half an boor after tbe applicattoo 





DISEASES DUE TO GASES, VAPOURS, ETC. 8i 



coat of paint another covering can be made. To the owners 
of the ship time is money. The danger arises when ibe 
vorkmen have to cover in a short time an extensive surface 
with the paint, and especially in confined spaces. 

The colours which form the bases of the paints, Instead 
of being ground with oil, arc mixed with methylated or 
petroleum spirit or with benzine, and while it is the 
iplrit which confers upon the i>aints their quickly <lryinB 
properties, it at tlie same time renders them extremely 
dangerous to the workmen, both by Inhalation of the 
npour and its extreme inflammability. Men when 
painting the interior of a ship's bunks have frequently 
had to be removed by ropes in a state of uncon- 
9cioiisnes3. In other instances, when working with naked 
lights, the vapour from the paints has caught fire and serious 
injuries have been inflicted. One man whom i saw was 
extensively burned on the arms, trunk, and face, and he 
lan the risk of dying from blood-poisoning. When men 
»re «-orking in a confined space they are frequently so 
overpowered by the spirit vapour that they are unable to 
extricate themselves from their perilous position. Many 
of thena go to sleep and are found in a state of narcosis 
or coma. Dangerous as is the use of these rapidly drying 
paints in the interior of ships, their use externally is equally 
attended by risk. Sometime:^, and without any explanation, 
aoless it be that a soft gust of wind had fanned a naked 
tight or blown a spark, the outside of a ship which men are 
painting Is suddenly and for a moment or two enveloped 
in flames. After painting bunkers with quickly drying 
paints the men often complain of headache, di^eziness, and 
unsteadiness In walking. They feel as if they were intoxi- 
cated. After vomiting they obtain relief. When men have 
been hauled out of the bunks In a state of unconsciousness 
Ihey have generally been found to be pale and to look ill, 
the breathing has been difTicult, and there has occurred bleed- 
ing at the nose. By d^ees the symptoms improve with 
the exposure of the men to the fresh air, but for a day 
or two they remain shaky and nervous. On getting the men 
home they should be put to bed and given warm drinks. 




82 



DISEASES OF OCCUPATION 




To pm-ent such accidents as have been alloded to, naked 
lights should not be allowed where quickly drying paints 
arc used. The electric light is safer. The greatest ventila- 
tion possible should be obtained. No man should work 
in a ship's bunk for more than an hour or two at a time : 
he should come out into the fresh air now and then or be 
viMled [periodically by a foreman to see that all is right. 
On undertaking the work for the first time the men ought 
to have all the dangers pointed out to them, both as regards 
the risks from inhalation of the vapour and the risks from 

Dry CUaning by Means of Benzine 

The dfy cleaning of goods by bcnrine is now an esta! 
lished industry and gives employment to large num 
of people. For cleaning gloves and stained garments 
nothing is better than benzine. Naphtha is occasionally 
used tor larger clothes. The soiled articles are usually placed 
first in a revolving drum containing naphtha and soap 
and subsequently in naphtha alone. The work is carried 
on in out-buildings in which no naked lights are allowed. 
Instead of naphtha, benzine may be employed. This may 
be a petroleum spirit obtained from mineral oil or from 
coal-tar. The two dangers incurred by the use of these 
spirit compounds are intoxication of the workers and risks 
from fire. Before any wearing garments that have beea^ 
sent to be cleaned arc placed in the revolving drum thi^^ 
pockets have to be carefully searched for matches ; these and 
all brass buttons have to be removed, for explosions have 
occurred owing to friction or electricity or the accidental 
ignition of the spirit by lucifcr matches concealed in the 
clothing. As there is always a danger from fire the men 
are not allowed to smoke in the building. Once the 
garments have tieen sufficiently rinsed in the hermetically 
dosed revolving benzine cylinder, they are romov<NJ and 
placed in a machine known as a hydro-extractor for the 
removal of excess of spirit. On being taken out of die 
hydro-extractor the garments are rinsed in clean spirit, 
are again placed in the hydro-extractor, removed, dried 
and finished. 




.DISEASES DUE TO GASES, VAFOURS, ETC. 83 



In ways that are quite unaccountable fires often break out 
in dry cleaning cstablishmcnt-s. In one dr^' denning shop 
which I visited lircs and explosions had on eight occasions 
occurred during fifteen years. These fines often break out 
on a hot summer sultry evening several hours after the 
workpeople have left the buildings, a circumstance which 
has led several persons to believe that benzine has a 
tendency to undergo spontaneous corabualion. At any 
rate, in most instances the origin of the fire has remained 
t mystery. Too great care, therefore, cannnt be taken in 
regard to the manipulation and storage of bensinc. 
Materials that have been soaked in it or scrubbed by it 
siioitld on no account be brought near a naked light, and 
the waste naphtlia and benzine should not be allowed to 
pass directly into the drains and sewers, for as they give 
ofl^ vapour and as men with naked tights arc often obliged 
to enter sewers, explosions might readily occur. 

Benzine vapour afTccts people differently. Young persons, 
and especially young females, arc more liable to be 
influenced by it than other people. They become hysterical 
and excited— they feel as if they were intoxicated. Sub- 
sequently they complain of headache and they vomit. On 
going out of the workroom into the fresh air the symptoms 
may pass away. Upon some persons bcnrine produces 
a heavy, sleepy feeling, a sense of languor and weakness 
of the limbs. In the severer forms of poisoning by benzine 
women have suffered from blindness, multiple neuritis 
attended by loss of power in the limbs, alteration of the gait 
known as " steppage," accompanied by loss of the knee-jerk, 
(lifEcul^of speech.and mental depression or halludnations. 
Recovery may be incomplete, for memory is oflcn impaired. 
.Naphtha produces similar symptoms but no serious 
permanent cfTects. Workers in the naphtha departments 
of indiarubbcr works often become anaemic and sufTer from 
headache. Their headache is relieved by going out into the 
open air. The women become aii.-emic often through being 
unable to take food ; the taste of the naphtha vapour 
lifters long in the mouth, so that the workers arc unable 
1 to eat 



84 



DISEASES OF OCCUPATION 



Allusion has been made to thenecessi'ty of ventilating very 
freely all places where benzine and naphtha are employed. 
No food should be taken into the workroom. Provisioo, 
should be at hand for extinguishing fires. There ought 
be an aiitoniatic 6rc extinguisher on the revolving drums tc 
which the garments arc agitated along with the benxinc;' 
also plenty of loose sand ought to be lying at hand, and 
plenty of blankets ready to throw around any person whose 
clothes have caught fire. The outer garments worn by the 
workpeople should be made of wool. Where dry cleaning 
establii^hments are several storeys high there ought to be lire- 
eseapes in accessible places. 

There arc not many cases of fatal poisoning by benzine on 
record, but in a case reported by Santesson of Stockholm the 
lesions found after death were — fatty degeneration of the 
heart, liver, kidne>'s and of the endothelial lining of the small 
blood-ve$sels. In "Poisons Industriels," p. 54, mention is made 
of a patient of Lenoir and Claude. The man, who was a 
dyer, aged 27, in consequence of inhaling the vapour of 
beni-ine died from purpura hemorrhagica. He had also 
bleeding from the nose and gums, and hemorrhages into his 
pleural cavity. The experiments carried out by MM. A. 
ChasKvant and Marcel Garnier, and reported in Arduv 
InUmal. de PkarmacodyttatHu et de TkirapU, 1905, show 
wliat a pcnsonous liquid benzine is. They injected small 
quantities into the peritoneal cair-ity of guinea-pigs. Three 
to five minutes after an injection of benzine there was 
general muscular tremor, so that the animal would lie down 
on its sida The amplitude of the convubions became 
greater as time went on, accompanied by a complete loss of 
the muscular tonus, so that the animal's body could be bent 
in all directions, This hypotonus did not appear at the 
same time as Che convulsive tremors — generally half an hour 
aderwards. There was also a marked fall of the temperature 
of the body. U the dnsc was sufficiently poisonous to lead 
to a fatal tenninatioii, the symptoms mentioned continued 
until death, but even with small doses there was always a ftll 
of temperature With a small toxic dose death came from 
d^ht to nine hours after an injectioo, but if the dose 



w 



^1 



DISEASES DUE TO GASES. VAPOURS, ETC. 85 

Urge the animal died in less than three hours usually after a 
severe convulsire seizure and complete h)^otonus. 

On making a post-mortem examination of animals poisoned 
by the injection of bcniine into the peritoneal cavitj- there is 
detected a stronj; odour of benzine when the abdomen is 
opened. Occasionally there is a small quantity of a reddish 
liquid in the peritoneal cavity, the serous membrane of which 
is frequently conRcsted, and shows numerous small 
Gcchynioscs or minute effusions of blood. The abdominal 
organs arc usually of a dark red colour, although the liver here 
and there shows a few white spots. The mucous membrane 
of the stomach along the great curvature is found to be the 
scat of numerous small brown patches and ccchymoscs ; 
letimcs there is ulceration. Since the benzine under 
se circumstances was not swallowed, it is e^ndent that 
as the minute hsmorrhages in the stomach bear a distinct 
relation to the course of the arteries, they arc due to the 
dimhiation of the poison from the blood by the mucous 
membrane of the stomach. Jn acute poisoning by benzine 
the earliest symptoms arc on the side of the nervous system, 
viz., convulsions, loss of muscular tone, and extreme depression 
of the body temperature. Death may come from the nervous 
system alone ; but, as already stated, if life is spared for a few 
hours, the gastro-intestinal canal becomes implicated, for the 
lesions found therein bear strong evidence of an effort on the 
part of the oi^anism to eliminate the poison by the mucous 
membrane of this canal 

Pe/ivl 

As a consequence of exposure to the vapour given off by 
petrol, workmen at the end of the day. especially if they have 
been working in a conBncd space, often complain of hcad- 
Kche, vertigo, nodding of the head, and discomfort in 
breathing. These symptoms are extremely apt to occur in 
men employed in die distillation and refmement of petrol. 
In cleaning out the tubs for holding petrol men have become 
asphyxiated, Wielczylc states that among the miners em* 
ployed at the petrol springs in the Carpathian mountains 

;)byxia is not unknown. Petrol vapour, like that of benzine, 



86 



DISEASES OF OCCUPATION 



destroys the colouring matter of the blood. To this circum- 
stance may be attributed the anxmia occasionally observed 
in the workmen. 

Owing, amoHR other things, to the prosperity of the motor- 
car industry, the demand for petrol within recent years has 
much increased. Special steamers have been built for 
bringing petrol from Sumatra and other places to this 
country. Some of these steamers carry enormous quantities 
of petrol, aa much as 1 3,000 tons. A certain rink attends no^J 
so much the filling of the tanks and the transport of thi^| 
material, as the cleaning out of the tanks after the cai^o has ■ 
been discharged. The petrol is shipped in specially prepared 
tanks, and care has to be taken that the tanks are well filled. 
Ventilating shafts run from these tanks to the mast-head of 
the ships. After the ship has been docked and the petrol 
removed, men descend to clean the tanks. Peculiar 
symptoms have developed in the workmen, tn the minor 
forms of petrol poisoning the men have become intoxicated 
and excited, others have become hysterical ; while in ihe 
deeper forms of poisoning the men have been so overcome 
by the vapour that they have passed into a state of coma, in 
which they would probably have died had they not been 
hauled on deck and allowed to breathe fresh air. The men 
become asphyxiated by the vapour, and on recovery often 
vomit and complain of severe headache, tn order to prevent 
such accidents it is necessary, before allowing men to go into 
the tanks, to close down all the hatches and to introduce 
steam into the tanks. By this means the petrol vapour 
seems to be robbed of its power for harm, so that men c, 
enter and by means of tow clenn out the tanks. Owing 
the inflammable nature of petrol vapour all fires and naked 
lights on die ship have to be extinguished during the 
emptying of the cargo. 



our 



4 



BUaiiit'Slffving 

Blanket-stoving was not considered to be an unhealthy 
occupation by a committee appointed by Mr. Ascjuith, when 
Home Secretary, nor by Dr. I. A. E. Stuart, of Batlcy, who I 




DISEASES DUE TO GASES, VAPOURS, ETC. 87 

had a large experience of the workers, since he finds that the 
mean age at death of the men employed is 64*1 years. The 
men sufler from an irritating cough, occasionally accompanied 
by the expectoration of a small quantity of blood, during and 
after the removal of the blankets that have been exposed 
to the fumes of brimstone in the stoving-housc. Most of this 
part of the work, the object of which is to bleach the 
blankets, is carried on in the winter months. During the 
summer the blankets are dried ouLiidc, and as this work 
necessitates the fixing and stretching of the biankets upon 
tenter posts it entails considerable physical effort on the 
port of the workmen. There is a common belief in the 
district where the work is carried on, that the men who are 
exposed to the sulphur fumes do not become the subjects of 
tuberculous lung disease, an opinion which medical experi- 
ence rather confirms than otherwise A similar immunity to 
infectious diseases is also conferred. The men drink beer in 
large quantities, owing, it is said, to dr)'ncss of the mouth 
and throat, caused by work tn the drying-house and the 
heavy perspiration which this causes. From the nature of 
their employment, the inhalation of sulphur fumes and 
alternating exposure to heat and cold, several of the men 
become the subject of chronic bronchitis and emphysema of 
the lungs. Although there h a remarkable freedom from 
tuberculous lung disease, yet phthisis and pneumonia arc not 
unknown among the workmen. Taking the work generally, 
it cannot tic said to shorten life, since the average age at 
death of blanket-stovers in 64'!. EfTictcnt ventilation and 
machinery for raising and stretching the blankets upon 
tenters would help to make the employment even healthier 
than it {9. 



CHAPTER HI 

DISEASES DUE TO WOKKINC IN CAISSONS AND 
COMPRESSED AIR 



ENGINEERING science has done much for the comfort 
of man and played no unimportant part in the cause 
of civilisation. By the extension of railways national barriers 
have been broken down and physical difficulties overcome 
that well-nigh seemed insuperable. A century ago, when it 
was necessary to span a river by a bridge, the sustaining pier* 
in the centre and sides of the river often rested upon huge 
pilc3 of wood that had been driven into the soil, but in 
modern days the bed of the river is attacked by engineers in 
quite a different manner. Men work on the bed of the river 
and below it in closed iron cylinders, or caissons, into which 
compressed air is driven by means of |>owcTful machinoy, fl 
and as excavation proceeds the caisson sink.s by its own ^ 
and superadded weight until solid rock is reached, or a i 
condition of soil Is attained capable of sustaining the caissoa, fl 
which, when filled with concrete, becomes the substructure of 
the pier of the bridge. Although all the required operations, 
mining and engineering, arc carried out in harmony withj 
physical laws, yet the conditions under which the men work: 
arc unnatural, and arc therefore attended with considerable 
risk to the health and life of the workmen, hence the terms 
"caisson disease," or "compressed-air illness." 

A caisson in Its simplest form is, when in position, an IronJ 
cylinder, somewhat bell-shaped, and open at its loi 
extremity. Its upper extremity is closed in by an iron roof,] 
but tills is really the floor of a smaller superadded chamberi, 
part of the roof of which along mth the floor already men- 

88 



CAISSONS AND COMPRESSED AIR 89 

tioncd is movabte so as to allow of the passage of the 
buckets filled with the soil removed by excavation. This 
Dppcr chamber is known as the "material " chamber. Built 
on to the outer side of the upper part of the caisson is an 
iron chamber, entrance into which is guarded by a strong iron 
door. Leading out of this chamljcr is a doorway that con- 
ducts into the interior of the caisson. This entrance into the 
caisson is also guarded by a strong iron door. The chamber 
jast ilescribed is that through which the men enter and leave 
the caiitson. It is known as the "air-lock." By means of 
strong iron pipes connected with a compressor engine, ntmo- 
^eric air is pumped into the caisson, which drives the water 
out of the caisson and keeps it out, so that men can work in- 
side ihe iron cylinder on the bed of a river and remove the soil. 
The workmen enter the caisson through the air-lock. Once in 
the air-lock the outer door is closed, either by the men them- 
selves or by some one outside. The inner door which leads 
frocn this chamber into the interior of the caisson is at this 
time also closed; it is kept thus by the pres.iure of the 
compressed air within the caisson. When the men have 

^e/ot comfortably into the air-lock, compressed air from the 
^KUsson is, by means of an air-cock, allowed to escape into 

^to: air-lock. The air-cocks which admit the high-pressure 
air ore made purposely smalt so as to prevent too rapid 
compression which, if it occurred, might give rise to 
troublesome symptoms. As soon as the pressure in the 
air-lock comes to equal that inside the caisson the inner 
iron door opens, practically speaking, of itself, when tlie men 
eater the caisson or working chamber, and by means of an 
Iron ladder descend to the bed of Uie river. During the short 
time the men arc in the air-lock preparatory to entering the 
working chamber, they are undergoing what is spoken of 
as "compression." The stop-cocks arc manipulated by 
trained men inside and outside the air-locks. Men who are 
undertaking the work for the first time occasionally experience 
considerable discomfort during the process of compression, 
the pressure rises within the air-lock the drum of the ear 
forcibly driven in, and some men not only become deaf 
but experience 5e\'ere earache, and headache attended by 




9* 



DISEASES OF OCCUPATION 



dizziness. Men who arc used to the work obviate all of these 
by swallowing air and passing it up the Eustachian tube into 
the middle ear, so that by the presence of this air-pad on the 
internal side of the drum of the ear the painful depression 
of the membrana tympani is prevented. In some instances 
where such preventive measures have not been empioyed the 
dnini of the car has ruptured. During compression the 
blood keep<t absorbing the gases of the air until the ten»OQ 
01 the gases in the blood becomes equal to that in the com- 
pressed air. Once this equilibrium has been attaiiKd 
immunity from immediate troubles is secured. Barring 
accidents, the men can work in the caisson for hours with- 
out experiencing any inconvenience, the amount of work 
done in a Ei\'cn time being equal to that which the men 
could do if similarly emplo)'ed outside a caisson. The 
opinion has been expressed that the work inside is not so 
fatiguing. Formerly caissons were illuminated by naked 
lights, but the smoke from the lamps and the con^tumption of 
the oxygen of the air polluted the atmosphere. The ele 
light has supplanted all other illuminants. When the bucket 
have been filled with soil they are hauled up to llic material 
chamber, part of the floor of which slides so as to allow them 
to pass through. The sliding doors arc at once closed by the 
men in the caisson who superintend this transport of the soil. 
For the next few moments the " material-lock" is a compressed- 
air chamber. After a brief period of decompression the roof 
of this chamber is opened by men outside the caisson, when 
the bucket is lifted by a crane, emptied, and returned, and when 
the roof again closes compressed air is turned on, the floor 
slides, and the bucket descends. So perfectly do the movable 
doors l]t and so adaptable arc the manipulations, that there 
is, practically speaking, no escape of the compressed air. 

At the closeof a shift, or when the men inside the caisson have 
finished their work for the day, they ascend the ladder, enter the 
air-lock, and close the door which .separates the caisson from 
the air-lock. As the men are still in compressed air the outer 
door remains firmly closed. By means of a stop-cock air is 
allowed tocscapcinto the externa! atmosphere, and bydegrees 
the pressure in the air-lock falls. Wlien the pressure inside 



b'on ^(\ 
lectiM 
ucket^ 




CAISSONS AND COMPRESSED 



9' 



the air-lock equals that of the external atmosphere the outer 
door readily opens, and the men emerge envcIope<l in a thick 
mist or fog, for during decompfession the air in the air-lock 
becomes extremely cold and saturated with aqueous vapour. 
It is while the men arc coming out of the air-lock, or shortly 
after having undergone what is known as " decompression," 
that there occur the dangers to health and risks to life. 
The caisson just described is such as is used in subaqueous 
excavations in vertical positions ; but large caissons ina>' be 
employed with two or three shaf^, each fitted in its upper 
extretnity as already stated. In making tunnels under a 
river, or under the streets of a large town, caissons are also 
employed ; these diflfer slightly in construction from those 
used on ri\-ers, but the principle is the same. 

To enable the men to do their work well when in the 
caissons pure air, and an abundant supply of it, ought to be 
pumped in by the compressor engine. There has generally 
been a considerable amount of sickness among the workmen 
when the supply of atmospheric air has been insufficient, or 
when it has been rendered impure by gases given off from 
the soil the men arc excavating. In sinking the foundations 
for the fHcrs of the King Edward Bridge at Ncwcastlc-upon- 
Tyoe the greatest amount of sickness among the men occurred 
when they were passing through a layer of soft coal below 
the bed of the river. Probably small quantities of carbon 
monoxide gas were given off, or sulphuretted hydrogen, for 
the men complained of a disagreeable odour. The ventila- 
tion of the caissons should be kept free by an excess of 
air pumped in at the upper extremity of the caisson and 
allowed to force its way outwards by the lower extremity. 
The air inside the caisson becomes vitiated by the respiratory 
products of the men, of whom, according to the size of the 
working chamber, there may be as many as from three to 
forty inside. In the large caissons on Tyneside thirty-five 
men worked at one time. As the men when inside the 
caiison work hard and consume large quantities of oxygen, 
the necessity for an abundant supply of air is apparent. 
At the Blackwall Tunnell, Sncll ■ found that white the esti* 
■ •■ Coinpruiscd-air lllnoV' £■ Hugh SneU, U.D. 




93 



DISEASES OF OCCUPATION 



mated number of cases of illnc&i for loo days was ^'9 when 
less than 4,000 cubic feet of fresh air per man per hour were 
supplied, iLiid 22-; when the amount was 4.000 to 8,000 cubic 
feet, the numbers fell to 8'5 when upwards of 8,000 cubic 
feet of air were supplied. It is Dr. Snell's opinion that the 
amount of illness varies inversely with the amount of fresh 
sir supplied. Experience to some extent confirms this theory, 
but the actual part played by carbonic acid gas in the pro- 
duction of caisson disease has yet to be demonstrated. It goes 
without saying that the health and safety of the workmen 
are enhanced by the supply of air being abundant and pure 
As compressed air is hotter than ordinary atmospheric air, 
the temperature at which the men arc working in the caisson 
is considerably higher than that of the outside air, conse- 
quently a layer of cold water should be kept circulating 
round the cylinder of the compressor engine to keep the 
temperature low and the air cool, and only high-Hash oils, 
500*^ F. and upwards, should be employed, so as to pre- 
vent the possible contamination of the air by the decompo- 
sition products of an over-heated oil. The surplus air escapes 
in tremendous volumes by the cutting edge of the caisson, or 
that part which rests upon the soil, but should, perchance, 
the bell-shaped expansion of the caisson settle down upon 
a bed of clay, and no air escape, as what occurs in what is 
called a " v/atcr-tight " stratum, there would be danger were 
there no safety-valves present in the upper part of the caisson 
to act automatically when the pressure rises too high. Safety- 
valves, too, are provided on the compressor engine, so that 
the "cut out" acts immediately the pressure has risen too 
high. There should always be at least duplicate compressor 
engines. Owing to the large size of the caissons employed 
by the Cleveland Uridge Company on the river Tyne, their 
extreme weight, and the possibility as they keep sinking of their 
tilting over on one side, or of suddenly sinking into the soil 
and crushing the men between the soil on the one hand and 
the roof of the working chamber on the other, strong iron 
girders were built transversely across the ulterior of the 
caisson, and the men were never allowed to work underneath 
a girder. Two such girders spanned the interior of each of 




CAISSONS AND COMPRESSED AIR 93 

the targe caissons on the Tync and divided it into three 
chambers. Through a large circular opening in the girders 
the men could pass Trom one chamber to another, and in the 
event of such an accident happening as the sudden tilting of 
the caisson, the air supply and the ventilation would hardly 
have suffered. As the caisson sinks it is steadied by a Urge 
amount of concrete that surmunds it. Mr. Frank Davis, the 
roanagcr of the Cleveland Bridge Company's operations on the 
River Tync, informs nuc that some of the caissons when filled 
with concrete, and that which is <^ui>crposed, weigh upwards of 
lObOOOtons. In bridge building the caissons are not removed; 
Ihey are filled with concrete and become the substructure upon 
which the masonry is reared. They form the piers of the future 
bridge. As the men inside the caisson can readily communi- 
cate by means of knocks with the men outside, there is no 
neces5it>' for having telephones inside the working chambers. 
Fortunately accidents happen but rarely inside the caissons; 
still it would be well to have inside the caissons a slii% 
or other suitable appliance whereby injured men could be 
hoisted to the level of the air-lock should the need arise. 
As the caissons keep sinking owing to the removal of the 
soQ, fresh lengths have to be added to the shafts, but air- 
locks must be always above htgh-water lc\'el mark. The 
pressure within the caisson has to be regulated according to 
the depth at which the men arc working and the circum- 
stance as to whether in tidal rivers the watcr-lcvcI mark 
is high or low. 

It requires i lb. of air pressure to displace 2 feel 4 inches 
of water. Ten metres of wat<.-r arc equivalent to one atmo- 
sphere of pressure. For every 33 feet of water a pressure 
of + 1 5 lbs. to the square inch, or r atmosphere, is required 
to keep the water out of a caisson. Men, if working at a 
depth of loo feet, would require a pressure of -l- 3 atmo- 
spheres, or 45 lbs. in the caisson. 

Among the earliest cases of " corapresscd-air illness " to be 
reported were those of Pol and Watellc in 1854, whose experi- 
ence was gained while in charge of sixty-four men who were 
working in caissons at 48 lbs. pressure on tlic River Loire. 
The men worked only four-hour shifts, and the time spent in 




94 



DISEASES OF OCCUPATION 



decompression was half an hour. Forty-seven of the men 
stocx! the work well, twenty-five had lo be discharged through 
Illness, and tu-o dkd. The serious cases numbered sixteen, 
all of which occurred after decompression. 

Caissons were first employed in England at Rochester in 
1851, by Hughes, during ihc construction of a bridge over 
the Mcdway, and shortly afterwards by Brunei at Chepstow 
and Saitash. At SalUsh one man died shortly after comingr 
out of a caisson in which he had been working at a depth of 
of 87*5 feet and under a pressure of 40 lbs. At the St. Louts 
Bridge, on the Mississippi, 600 men were employed in sink- 
ing the foundations. Of these 600 men, 119 suffered from 
caisson disease, 14 of whom died. At the Brooklyn Bridge, 
New Vork, there were 1 10 cases of compressed-air illness, 
with 3 deaths. The Forth Bridge and the Blackwall Tunnel 
were the 5rst works using high pressures which were cor 
pleted without a fatality. Mo death from caisson dia 
occurred in the Baker Street and Waterloo Railway tuno( 
works in London. At the King Edward Bridge, Newcastle- 
upon-Tyne, one man died from the effects of caisson disease 
attended by complications. 



SympiQtns of Compnssed-air Illness 

The pathological effects of compressed air occur at 
diflcrent periods, (1) when the men arc undergoing pressure, 
and (2) during or after leaving the pressure. The symptoms in 
the 5rst instance are mostly mechanical, as, for example, 
pains in the cars already referred to and due to the prcssui 
upon the membrana tympani, also pains in the frontal and 
maxillary sinuses. By inflating the middle ear through the 
Eustachian tube the men can prevent the« unpleasant symp- 
toms. Unless the drum of the ear ruptures and is followed 
by acute inflammation, the symptoms require no treatment. 
It is otherwise with those that belong to the second category*. 
These may develop while the men are in the air-lock under- 
going decompression. This Is a rare event inside the air- 
lock, but it occurred in one of my own patients, the only case 
occurring in Newcastte-on<Tyne that proved fatal. In some 




CAISSONS AND COMPRESSED AIR 



95 



instances the men have had to be lifted out of the air-lock in 
a condition of unconsciousness. These are always serious 
cases, especially if the coma is attended by convubion& 
Usually the symptoms do not show themselves for some 
time — a few minutes, half an hour, or several hours after the 
men have come out of the air-lock. In an ordinary way the 
mm complain mostly of severe pains in their muscles and in 
their joints, which they call " bends." The knee-, elbow-, and 
hip-joints are, as regards frequency, individually affected in 
the order mentioned, but they and other joints may be 
simultaneously affected. Often the pains are excruciating 
and cause the strongest men to writhe in agony. The earlier 
the pains develop after the workmen emerge from the air- 
lock the more severe they are. " Bends" may continue for a 
few hour.i or for two or three days. I have frequently 
grasped the aching limbs of the men suffering from " bends." 
but neither pressure upon them nor friction of the joints 
teemed to aggravate the pains. Occasionally the men after 
tJecompression bleed at the nose, or they complain of severe 
ibdominal pain and vomiting. In many instances it is only 
after the men have left their work and are on their way 
bomeu-ards that they are seized with extreme pains, or they 
become paralysed in their limbs and fall. It is the lower 
extremities that are paralysed. The loss of power in the 
iegs may come on several hours after decompression, and 
may be transitory or permanent. This paralysis is accom- 
panied by retention of urine, requiring; the use of the catheter. 
Vertigo is not an uncommon symptom. Under its influence 
workmen may be seen to stagger and stumble as if intoxi- 
cated. One of my patients was the subject of acute delirium 
for a few days, two others were enfeebled mentally, and for 
a time were childish and almost imbecile, while several others, 
again, were nervous and appeared to be the subjects of un- 
accountable fear. Occasionally there ts temporary but partial 
blindness without opthalmoMopic changes in the retina to 
explain the loss of vision. Double vision, and loss of hear- 
ing with facial paralysis, have occurred. Some of the men 
become nervous and hysterical. In other instances it is 
difficult to say whether they are not malingering. In the 




96 DISEASES OF OCCUPATION 

minor forms of caisson disease the muscular system and 
joints are most affected ; in the severer forms it is upon the 
central nervous system that the brunt of the illness mostly 
falls, the spinal cord more than the brain. 




lyjiaJ art iki Sytftfiioms due to? 

In^iide the caissons the men are working under abnoi^aF 
conditions. The air-pressure is high and the work is hard. 
There arc no signs of illness so long as the men are in the 
compressed atmosphere if the air is good. It is after the 
men return from a high to a low pressure that symptoms 
arise: The length of time spent in the working chamber, the 
purity of the air, the heiglit of the pressure, and muscular 
fatigue are predisposing circumstances. Men who arc work- 
ing a four or five hours' shift are more likely to beconie | 
affected than other men working at the same pressure for 
only half the time. In this country the men seldom work 
under pressures higher than 35 lbs. to the square inch ; 
to this must be added the ordinary atmospheric pressure 
of 15 lbs. Since 1 lb. of air pressure is required to dis- 
place 2^ feet of water, the pressure just mentioned would 
correspond to a depth of 70 to 80 feet below high-water level 
mark if the work was being carried on under a tidal river. 
The pressure is caused to vary with the rise and fall of the 
tide. According to the depth at which the men are working, 
and therefore the pressure, so should be the length of the 
shift The higher the pressure the shorter ought to be the 
shift. It was when the men were digging through a layer ot 
soft coal below the River Tyne tliat there was experienced 1 
an unpleasant odour and there was the greatest amount o^fl 
sickness, and at the Forth Bridge it was when the men we»e^l 
removing the soft silt on the bed of the river that Dr. 
Hunter had the largest number of men off ill. Impurity 
of the air is a factor in causing illness, not necessarily 
of the typical character of caisson disease, but which 
places the individual Mors dc combat. It is difficult to 
estimate the part which excess of carbonic add, for example. 





CAISSONS AND COMPRESSED AIR 



97 



Snell's observations on this point are perfectly clear. 
The amount o{ sickness was found to be proportional to the 
quantity of carbonic aci<l in tlie air. An increase of carbonic 
add from x)4 per cent, to oi per cent at 30 lbs. pressure was 
always the forerunner of much illness. Dr. F. R. Wainwright, 
who had roedical charge of the men employed at the Hakcr 
Street and Waterloo Railway tunnel, found that •* from 
May 23rd to October 4th, with an average uf 6,000 cubic feet 
(of air) to each man per hour, there were 34 cases (of illness), 
siy S cases per month. Following this with an average of 
LjcxD cubic feet to each man per hour, there were 1 3 cases in a 
period of 12 days,'' and the cases occurring^ during the latter 
period came on sooner after decompression and were more 
severe than chose that occurred when the ventilation was 
better. On the River Tync the amount of frc&h air pumped 
into the caisson was only 1,320 cubic feet per man per hour, 
and >'et there were very few cases of illness. At the 
Brooklyn Bridge the air in the caissons contained 0'33 per 
cent, of carbonic acid, but at the Baker Street and V^'aterloo 
Railway tunnel it was 0^06 to 0x17 per cent. Even when the 
mca were working at a maximum pressure of 3O lbs. at 
Brooklyn, Dr. Smith, who was in medical charge, reported 
1 10 ca»es of compressed-air illness in four months, whereas 
at Baker Street, with eight-hour shifts, there were only 47 
cases in 6vc months. Dr. Smith docs not attach much 
tfnportance to the ventilation, for he remarks that "this 
amount (0*33 of CO3) of vitiation was found not to affect the 
men unfavourably." Snell's and Wainwright's ubser^'ation, 
theoretical considerations, and the Brooklyn Bridge statistics, 
suggest the existence of some relation between volume of air 
supplied with the quantity of COa contained in it, and the 
amount of sickness in the men, but precisely what that 
relation is it is difficult to say. Wild rata which I exposed 
to 50 \hs. pressure of atmospheric air, containing quantities 
of COj varying from 06 to i-cl|. per cent, for seven hours, 
behaved differently : some experienced little or no incon- 
venience, while two or three, although on removal from the 
caisson they were apparently quite well, yet died a day or 
two afterwards. On examining tbeir lungs microscopically 
u 




98 DISEASES OF OCCUPATION 

there were Tound evidences of patchy congestion wit 
small hicmorrliages, also congestion of the IK'cr. A dog. on 
the other hand, was on several occasions for seven hours in 
compressed air which contained 0'3 to 2'i6 per cent of 
carbonic acid, and under a pressure of 50 Ihs. without ill- 
effects. He kept foiling asleep in the caisson, but beyond 
that nothing was obscr\'ed. 

On the River Tyne the amount of carbonic acid prcKcnt In 
one of the caissons on working days varied between 20 and 
30 volumes per 10,000, while the ordinary atmospheric air 
in the neighbourhood of the caisson contained 5 volumes of 
COs per 10,000: the amount varied between 0'2 and 0*3 per 
cent, and yet it cannot be said that there were many cases of 
compressed-air illness, notwithstanding the fact Utat only 
1,320 cubic foctof air per man were being pumped in. Oo 
the particular day in which the most serious case of illness 
occurred in the caisson the amount of carbonic acid was Ie» 
than usual. There have been several fatal cases of com- 
pressed-air illness at the Hudson River Tunnel. New York, 
but on carefully going into the figures and comparing them 
with the percentage of carbonic acid in the atr of the tunnel, 
there docs not appear to be such a constant relatioruihip 
between the two as to imply a causal connection. Notwhh- 
standing this it is desirable that the air in the caissons should 
be kept as pure as possible. 

It is interesting to remember that even oxygen, which is 
of all the gases the most important, from a viul point of 
view, becomes a poison when breathed in excess and in a 
compressed form. It produces tox.cmia and inflammation of 
the lungs. Paul liert, on exposing dogs to high pressures of 
oxygen and rapidly decompressing (hem, found that the 
animals became convulsed and that the amount of carbonic 
add in the blood became markedly diminished owing, he pre- 
sumed, to the excess of oxygen arresting the metabolism of 
the tissues, Assisted by Dr, Alfred Parkin, 1 carried out a 
scries of experiments at the Newcastle College of Medidne, 
with mice. Exposing them to high pressures of oxygen, say 
10 atmospheres and upwards, some of them died in cofi^ 
vulsions even when brought into ordinary atmosphe 






CAISSONS AND COMPRESSED AIR 



99 



wh0e others that came out of the compressed oxygen died 
a few days aftcrwardii from acute congc!stion of the lungs. 
Pneumoiita is one of the consequences of breathing ox^en 
under high pressure. Professor Lorrain Smith, of Owen's 
College, has suggested that inflammation of the lungs might 
be the cause of caisson disease, but as some of the worst cases 
of comprcsscd-air illness on the Tync occurred when the men 
were working at rather low atmospheric pressures, and there- 
fore not exposed to high-tension oxygen, and the lesions in 
caisson disease arc more in the nervous system than in the 
respiratory organs, it does not appear that oxygen tension 
nor congestion of the lung is the cause of comprcsscd-air 
illness. Under the atmospheric pressures at which the men 
are working in the caLisons, the oxygen tension is not high 
enough to cause pulmonary congestion. The convulsions 
produced in animals by high oxygen tension are in all 
probability the result of the toxic cITect of oxygen upon the 
central nervous system. 

Parkin and I found that mice behaved diflercntly in high 
pressures of oxygen and compressed air. Exposed to -f- lO 
atmospheres of oxygen, mice in seven or eight minutes 
became convulsed, but when exposed to even higher 
Btmosphcrcs of compicssed air for the same period no con- 
vulsions occurred, owing, probably, to the length of time 
being too short for intoxication to occur from the oxygen in 
the air. With high oxygen pressures convulsions develop 
during the period the animal is in the compressed-air chamber: 
the convulsions arc, therefore, in all probability toxic in origin, 
but with high pressures of atmospheric air symptoms do 
not arise until the animal has been decompressed, when the 
more sudden the decompression the greater the tendency for 
symptoms to develop. The symptoms in the latter instance 
arc due to quite a different cause, vi^., frothing of the blood 
in the small vessels. During the time men arc working In 
compressed air the circulation of the blood is-, practically 
speaking, unaltered. The pulse may be quickened at first, 
but this is temporary. On the other hand, some of the air 
the men are breathing is pressed into the blood under the 
high pressure and i& held therein in solution, the solution of 




100 



DISEASES OF OCCUPATION 



the piascs being proportional to the pressure In accordani 
with Dalton's law. Since nitrogen forms four-fifths of 
air we breathe, it is this gas which is found dissolved in 
largest quantity tn the blood in compressed-air illm 
Leonard Hill ' tells us that on one occasion when a com' 
presscd-air chamber suddenly burst, the dog which was the 
temporary tenant of Uie clmmbcr was killed, and that the 
blood removed from the right side of the heart of the animal 
yielded, on analysis, 15*3 per cent, of carbon dioxide, 82'S of 
nitrogen, and 2 per cent, of oxygen. Nitrogen of itself is a 
harmless gas: 100 cc of blood under 1 atmosphere of 
pressure will absorb i'23 cc of nitrogen and under 4 atmo- 
spheres 4*52cc. When decompressed from 4 to i atmosphere 
the same blood will give up 3169 cc. of nitrogen. It is 
estimated that the whole of the blood in the body of a man 
weighing 70 kilogrammes would give up 130 cc, of nitrogen, 
but his tissues and fluids would probably yield ten Urn 
more 

When the air In a caisson contains a larger percentage 
carbonic acid than usual, there is the danger of a larger 
amount of carbon dioxide being pressed into the blood under 
these circumstances. The e(Tect of the sudden decompression 
of a man who has been exposed to a high atmospheric air- 
pressure is exactly the same as what occurs when a bottle of 
soda-water is opened — elTcrvesccnce occurs : the blood as it 
escapes from the heart of an animal killed by rapid decom- 
pression can be seen frothing. On exposing pithed frogs to 
high atmospheric pressures and watching through a microscope 
the circulation in the web of their feet, it was noticed that 
while for a moment the circulation was quickened, the flow 
of bltx>d gradually returned to the normal and remained thus, 
nothing abnormal being detected as regards the calibre of the 
blood-vessels. When decompression is suddenly induced no 
immediate change occurs in the circulation. Two or three 
minutes afterwards, however, the blood stream is observed to 
become slower and slower, subsequently it oscillates in the 
vessels — now forwards, now backwards — and then there 
appears a bubble of air inside one or more of the capillary. 
' Laoftl, July t, 190J, p, 4. 



I 



JS AND COMPRESSED AIR 



rOT 



blood-vessels. Another bubble or two of air presently 
appears, and these coalescing fill a constderable part of a 
capillary. Where in the vessels there was previously bluod 
there is now air, and the circulation in that particular vessel 
ceases Occasionally there is a rupture of small btuod-vessel^ 
when air and blood escape into the tissues. It is the sudden 
setting free of the gas previously dissolved in the blood which 
is the cause of the frothing of the blood seen in an animal 
that has been killed by rapid decompression, and is the 
explanation of caisson disease or compressed-air illness in 
men who liave been working at bigh air pressures and been 
too rapidly decompressed. The bubbles of air arc for the 
most part nitrogen, simply because nitrogen is the largest 
constituent of atmospheric air and more of it is absorbed 
than of the other gases. While possibly carbon dioxide 
and carbon monoxide may be more dangerous to health 
when inhaled in the compressed form, and predispose to 
the de%-clopmcnt of certain symptoms, yet caisson disease 
is not so much the result of a toxiemia or poisoning as 
of the sudden liberation of gas and the presence of air 
emboli in the blood, rupture of capillary vcsscb, and the 
presence of free air and blood in the tissues. The symptoms 
are largely the result of mechanical causes. Frothing of 
the blood i.s the main cause of caisson disease. The longer 
the workmen arc in the caisson and the greater the muscular 
fatigue, the higher the pressure and the rapidity with which 
decompression is efTectcd, the more likelihood is there of 
caisson disease developing. As already stated, the symptoms 
arc met with mostly on the side of the muscular system and 
the joints ("^bends")^ As concerning the central ner\'ous 
system, coma and convulsions point to Che brain as being 
aflccted, and parnlysis of the legs to a lesion of the spinal 
cord. Of all the cerebro-spinal symptoms paralysis is the 
most common, owing to the lower portion of the spinal cord 
being that which is the most frequently a^ectt^d. Why this 
particular portion of the spinal cord should be so fre<jucntly 
selected has nc\xr been adequately explained. It has been 
attributed to the length of the smalt arteries in thb part of 
^Jhe nervous system and the comparative absence of external 



lOZ 



DISEASES OF CXCUPATION 



sapport to their walla. The following attractive theory 
lias recently been advanced by Dr. H. M. Vernon at a 
meeting of the Royal Society. In carrying out a scries of 
experiments to determine the ttoluhillty of air in various; fats, 
Vernon found that at body temperature the fat of mammals 
probably dissolves five times as much nitrogen as water or 
blood plasma. 1 1 is known that for caisson work men of spare 
build bear rapid decompression better than stout men. The 
spinal cord is rich in fat-like substances (30 per cent). 
Vernon suggests that this circumstance may account for the 
frequency with which .spinal cord legions occur in caisson 
workers, and if it could be shown that the bulk of the 
nitrogen is absorbed by the tissues and not by the blood, the 
view put forward by Vernon would be considerably strength- 
ened. It is said that no actual intercellular or intracellular 
liberation of air has been definitely proved to occur, but in 
my experiments upon pithed frt^s bubbles of air were fre- 
quently seen outside the capillary blood-vessels as well as 
inside of them, a circumstance which points to the absorption 
of the dissolved gas and its subsequent liberation in gaseous 
form by the intercellular liquid or lymph. The presence of 
gaseous emboli in the blood -ves.scls is acknowledged to be 
(he main cause of the symptoms of caisson disease, but 
microscopical examination of sections of liver and brain show 
that the tissues themselves and the lymph that bathes them 
had absorbed the gas. judging from the large number of 
circular spaces created by the bubbling forth of the gas. 
Vernon is of the opinion that the special liability of fat or 
adipose tissue to injury on rapid decompression is probably 
a resultant of two factors — "its greater solvent power and 
relatively limited blood supply." More gas would be di». 
solved, which, owing to the scanty supply of blood*vesseI^^ 
would with difficulty be removed. '^M 

It was Paul Bert — a Frenchman — who put the pneumatic 
theory of cai^^on disease upon a scientific basis. The bubbles 
of air usually appear fi rst in the venous side of the circulation. 
When decompression is carried out slowly, nature provides 
for the gradual escape through the lungs of the gases that 
have been dissoUed in tlie blood. This gradual escape 




CAISSOKS AND COMPRESSED AIR 



103 



gss through the lungs is the sa\'iour of the individual 
The danger incurred by workmen in passing rapidly from a 
high to normal atmospheric pre&sure is that bubbles of air 
arc Uberalai in the bUiod-VL'sstls and in the tissues, that the 
tissues arc thereby stars'cd or torn, and as a consequence 
function is lost. This explains the paralysis of the limbs. It 
would suggest, too, that if more time were spent over decom- 
pression fewer accidents would occur, a view of the relation- 
ship which we cannot but support. And yet serious cases of 
cooaprcsscd-air illness have ocairred when men have not 
worked under high pressures, say only 12 lbs., and when neither 
the shifts have been too long nor decompression too rapid. 
Jt is these cases that are difHcult to explain, and towards the 
elucidation of which Dr. George \V. 1*. Macnaughton ' has 
submitted the theory of frictional electricity as a factor in 
caisson disease As the work of a caissonicr is hard there is, 
in consequence of the muscular exertion, a repleted condition 
of the visceral veins as well as thosejof thccerebro-spinalaxis. 
When there is added to this circumstance the influence of the 
two or three extra atmospheres of pressure in which the men 
are working, the over-distended vessels create a local pressure 
which interferes with the nutrition of the nerve cells ; to this 
malnutrition the accumulation of the products of metabolism 
in the perilymph contributes. There is thus induced, accord- 
ing to Macnaughton, a local ri.sc of acidity which is a stimulant 
to the dischai^e of enei^y by those cells. Some writers have 
attributed the muscular pains and "bends" to the accumula- 
tion of carbonic acid and toxins generated during muscular 
exertion. It is maintained that the caisson atmosphere is 
charged with electricity carried in by droplets of water- 
vapour. The man who is working in this atmosphere 
"accumulates upon the body surface electricity which cither 
by directly permeating the tissue reacheii, amongst others, 
the nerve centres, or by acting upon the peripheral nerve 
filaments or muscle cnd-platcs stimulates these centres from 
the afferent side. Although the amount of electricity be in- 
sufficient to produce a conscious effect upon the exterior, the 
nerve cells arc thrown into a state of excessive activity, mani- 
■ LatKtt, Angiat 18, 1906, p. 435. 




io6 



DISEASES OF OCCUPATION 



foi3 

iseuB 



following facts. One hundred and twenty-IJve men ha% 
been working in the caissons ; of these 55 have had slight 
illness, most of these " bends," 9 have had ear trouble, r 
symptoms of Meniere's disease, and i isdetif. An important 
innovation has been introduced whereby the compressed air 
sent into the caisson is cooled by an ammonia process as tn 
the making of ice. This has answered most satisfactorily. 
Men who are the subjects of nasal or laryngeal catarrh or 
whOt on medical examination, arc found to have diseased 
lungs or a weak heart, ought not to undertake caisson work, 
nor !)hould any one who is known to be an alcuhuHc be aiIo>i-ed 
inside a caisson. All men ought to be primarily examined 
by a doctor. Young men between the ages of twenty and 
thirty, whose tissues arc still elastic, men who arc of rathet_ 
spare than stout build and who arc of regular habits, 
the best subjecti for caisaon work. After the age of foi 
five experience has shown that the liability to caisson dis 
increases. Too great attention cannot be paid to the evil 
effects of alcohol as predisposing to comprcsscd-atr illness. 
[ have been particularly struck by this in looking over the 
statistics and history of the fatal cases of caisson disease at 
the River Hudson tunnel works. Workmen on being t.xkcn 
on for the first time should have the dangers of the operations 
fully explained to them. Since caisson disease is the result 
of the liberation of gas in the blood and tissues, consequent 
in many instances upon too rapid decompression, contractors, 
engineers, and physiologists have given considerable attention 
to lliis part of the subject in the hope of finding a reme 
The greater the depth men arc working at and the lon{ 
the shift, the longer ought to be the time spent in dc 
pression. The difficulty is to get the men to conform to 
Coming off the shift fatigued they are eager to get he 
and as the process of decompression is attended by a 
marked fall of tcmpemturc, the men, who arc usually per 
spiring, feel chilly in the air-lock. In Amsterdam I found 
the owners provided the workmen with a blanket to wrap 
round their bodies in coming out of the air-lock. There is 
no reason why this chamber should not be heated. Thij 
would remove one of the causes of discomfort th< 




CAISSONS AND COMPRESSED AIR 105 

that there is .ttill much to Icam as regards the causes of 
c2isson disease. 

In this country men seldom work in caissons in higher 
pfessures than 30 to 35 lbs. per square inch. That men can 
"— ^i;re much higher pressures has been proved by the expcri- 
:s of Messrs, L. Hill and M. Greenwood, junr.' Pressures 
varying from 75 to 90 lbs. were borne without any serious 
discomfort or distress so long as the Eustachian tubes were 
open and air could be swallowed. The period of compression 
extended over 54 minutes, and the period of decompression 
lasted 2 hours 17 minutes. Notwithstanding the length of 
time spent in decompression neuralgic pains in the arms 
were experienced. There was abo considerable itching of 
the skin of the arms. On one occasion a purpuric rash 
appeared on the chesL Hill and Greenwood are of the 
opinion that to prevent symptoms the men on undergoing 
decompression should move their muscles and flex and extend 
their joints so as to aid the capillary circulation. These 
ph3rsiologist.s maintain that men can be submitted to a total 
pressure of seven atmospheres, or 105 lbs., without any un- 
toward effects so long as decompression is effected gradually. 
Treatment is preventive and curative. The Dutch Govern. 
nient has drawn out a series of excellent regulations for work 
in caissons. Having visited the tunnelling operations in 
Amsterdam necessary for the construction of a new railway 
viaduct, and having inspected the caissons and seen the 
conditions under which the men arc working, I can bear 
testimony to the care which is taken of the workmen by 
the contractors, and have little hesitation in saying that the 
Dutch regulations are well up to date. A similar remark 
applies to the carefully drawn-up regulations which the 
French Government has prepared for the guidance of 
employers and workmen. Professor Langlois's paper is an 
important literary contribution to the subject of compressed* 
air UlnessL 

At the time of writing the works at Amsterdam are not 
yet finished. Dr. G. Waller has kindly favoured me with the 

' Prtxudinp ef Ike Reyal Soady, Scries B, %-oI. 77, April, 1906, 
P- 444- 



io8 



DISEASES OP OCCUPATION 



rrom the caisson to alter our recommendation of sb 
<lecoiiiprcssion. One mitiule for every s lbs, of pressure" 
worked well enough on the Tync— one minute for every 
3 lbs. of pressure would even be safer. Wainwright says 
that at the Raker Street and Waterloo Railway tunnel 
it was possible to "lock-out" of 30 lbs. pressure in one 
and three-quarter minutes during the first three months of 
the excavating, but that afterwards the exit tap was altered, 
so that in order to leave the same pressure it required six and 
a half minutes. The alteration did not in the slightest d^rce 
alter the number or the severity of the cases. Snell, at the 
Blackwall Tunnel, had similar experience of the men under^y 
gtring rapid decompression without sufTcring. ^M 

When " bends " or more serious symptoms appear in men^^ 
after they have left the air-iock, the best thing to do is to 
rccomprcss them. At all works there ought to be a medical 
lock sufficiently large, so that the workmen can be laid in 
the horizontal position, and it should be sufficiently heated, 
so that all harmful influences of low tempcrattircs may 
be avoided. Immediately upon the development of severe 
symptoms the workman should be placed in the medical 
lock and rccomprcsscd. The treatment is so successful for 
even mu&cular pains or "bends" that the men, knowing the 
relief they obtain from it, frequently ask to be placed in the 
medical lock and recompressed Relief is ol^en obtair*ed 
after the pressure in the medical lock has risen to 18 lbs. ; in 
other instances not until it has risen to 25 lbs., or i or 2 lbs, 
higher per square inch than the men had been working iit. 
After a patient has been recompressed for some time, the 
pressure having risen to 20 or to 24 lbs., decompression 
should be extremely slow — an hour or even more should be 
spent in the process; or in other words, three minutes for 
every I lb. of pressure. The fact that symptoms do not 
develop for an how or more after a workman has left the 
caisson, probably when he has got home, is no reason why 
he should not be taken biick to the works, in a conveyance 
if possible, and placed in the medical lock and recompiiissed. 
Where no medical lock exists the ordinary air-lock can be 
utilised for tlic purpose of recompression, but the chamber. 



CAISSONS AND COMPRESSED AIR 



109 



ought to be heated. Where p;ttientR are being treated at 
home or in hospital for " bcntU," tbc muscular pains may 
socnetioies be so severe as to require the administration of 
morphia hjrpcKlcTmically. Other symptoms must be treated 
their own merits. 

tt has been suggested by H. Von Schrotter that caisson 
'workers should wash out the nitrogen absorbed during their 
work in high-air pressures by breathing pure oxygen for 
fiw oitnutes before entering tbc air-lock of decompression. 
Theoretically correct, the method has been proved to be 
cxpcaSmentally efficient in preventing death ftom air cm- 
bolisA). It would be unsafe to allow oxygen to be used 
if men were working at pressures above 50 lbs., since 
symptoms of oxygen poisoning in the form of convulsions 
might develop^ 

■ Diva's 

Men who arc engaged in diving for pearls and sponges, 
who are employed in searching for treasure in sunken ships 
Of in deepening liarbours by blasting rocks, run risks to 
health and life When native pearl divers have once got 
0%'Cr the initial pain-s in the ears and discomfort in the head, 
which all the.se men more or less experience, they can remain 
below the water for a sufficient length of time without 
aitifida] assistance in order to secure a few oysters, but they 
have to be careful of an open oyster closing and gripping 
their hand, for the grip when it occurs may mean to these 
men death by drowning. 

Pearl divers off ihc coast of Australia occasionally go to a 
depth of 100 to 135 feet, but at this depth they can only 
remain a very few minutes. Salvage divers have recovered 
treasure at a depth of 160 feet without injury. Dr. Alfred 
I'arkin, of Ncwcasttc-cm-Tync, in his "Thesis on Caisson 
Disease," states that llic greatest diving feat ever accomplished 
li that by Hooper, who made seven descents to depths of 
30I feet (87 lbs. pressure to the square inch), and on one 
occasion remained underneath 42 minutes. In order to 
become accustomed to changes of pressure and to obviate 
immediate risks to life, a certain amount of time has to be 



tto 



DISEASES OF OCCUPATION 



allowed both in descending and ascending. Neither mast be 
rjipidly done. Two feet per minute is the recommendation 
for tlie descent and ascent of divers when the depth does not 
exceed So feet, but as the depth increases so longer time 
niu-it be aliowe<l. A few minutes longer should be spent 
in ascending than in descending. 

Sponge seekers, the scaphandricrs of I'rench authors, also 
run considerable risks. Not a year passes without several 
lives being losL Through the kindness of Dr. Stef. Zog- 
rafidt, surgeon to the Royal Grecian Nary, who has been 
in charge of the temixirary hospital at Tripoli, Africa. 
and whose microscopical sections and drawings of the 
pathological lesions met with in the spinal cord of deceased 
sponge divers I ha\-e had the opportunity of examining, 
1 am able to give some of the information he has gained 
in his researches upon 290 clinical obscn'ations and seven 
poAt-mortem examinations. It was Leroy de MMcourt, of 
the French Navy, who^ in IS69. first drew sttention to the 
dangers incurred by sponge divers by too rapid atmospheric 
decompression. Scaphandriers wear the diving dress in- 
vented t^ Denayrottse. Zografidi ^Miks of three fbnns of 
dbease occurring in sponge divers as the result of rapid 
decocnpression. (a) the aemU or Hgktmuig (bnn, which ends in 
death ; or (J) passes into the ekfvmk state; accompanied by 
apasms; and (r) the mtiU fbnn, which is fleeting in its 
duration. In the acute form death may be immediate, or if 
life continues for a time, there is a typical mytiitis or 
inAammation of the spinal cord with fieves and complete 
paralysis of the limbs. This form abo asually ends in r^id 
death, or it is socceeded by chronic spasm of the Hrabs 
attended b)' loss of power. In the milder form of tlio 
malad)* the pbenonena may pass awmy without teavii^ any 
tnce of their existeDCCL After a }too% stay at the bottom of 
the na under a high pccssure. the spoost diver, if he makes 
ttM rapid an ascent to Uie sur&oe and tfaiss ondergoes 
too sodden dccompwnion. may die imBt ed iat dy. In the 
wor?! fonns of Ab naUdy the sd»ole body is swoUen and 
eaiph>r$ema(oi», owing to the pce aeoce of air in the tissaes ; 
fafeud ooMi fioa the mm. nmith, ean* and eyen and t hare 



CAISSONS AND COMPRESSED AIR 



III 



sn small haemorrhages into the skin. These cfises, fortu- 
nately, arc rare A less acute form, on the other hand, is not 
nncommon. Sponj^e divers descend three or four times a 
day, with the exception of Sunday, to depths varying from 
lOO to 350 feet Under a low pnr;sure they remain working 
(or 40 to 60 minutes, under a higher pressure they stay a 
shorter time, but under all circumstances, ZograHdi says, 
they come up far Umj quickly. The men live on board of 
uitall ships, and overcrowding is common. The ventilation 
of their sleeping-rooms is bad. Fatigutxl with the hard work 
of the day performed under the rays of an African sun, badly 
fed, for they live upon preserved foods ivhich arc highly 
salted and cause constipation, these unfortunate men, during 
six months of the year, follow a dangerous occupation both 
on the surface and at the bottom of the Mediterranean. 
The accidents to which they arc liable arc the same as those 
met with in caisson workers. Under high pressures the 
atmoiphen'c air is dissolved in the blood and tissues, and 
during sudden decompression there is a rapid diMrngagcment 
of the gas in the form of bubbles, which block the blood- 
vessels and tear the tissues. It is during decompression that 
danger is incurred. Sponge seekers who ascend too quickly 
to the surface of the water frequently complain of intense 
pain throughout the body, especially in the trunk, of derange- 
ments of sight and hearing, tingling in the limbs, followed 
sbortiy afterwards by paralysis. I f it is a more severe attack 
there is loss of consciousness. After persisting for a few 
hours, the paralj-sis in some instances disappears for half an 
bour or longer, during which the sponge diver may ^ct up 
and walk about feeling well, but a few minutes afterwards the 
tingling in the limbs returns, followed by lo&s of power in the 
limbs. For the next two or three weeks the patient lies a 
beipless wreck, paralysed in his lower extremities and with 
sensatton abuli-;hed, complaining of a painful girdle sensation 
round the waist and retention of urine followed by inconti- 
nence. Fever develops, pus appears in the uritic, and bod- 
sores form. The man dies from exhaustion and septicemia, 
and in his spinal cord arc found areas of inflammation and 
softening similar to those met with in caisson workers, and 



in 



DISEASES OF OCCUPATION 



due to the presence of bulla; of air and small )ia:morrh 
the result of the sudden liberation of gas. Dr. Zografidi says~ 
that the lightning form of the malady is always fatal, that i^ 
the acute form the mortality is 70 per cent, while in 
mild form recovery is ihe rule. As regards treatment, there" 
is, practically speaking, none beyond attention to general 
details. Oxygen is without any special influence. Zog- 
rafidi has administered the gas to patients, who have died, 
and he has withheld it, and patients have recovered. The 
treatment of the paralysis is simply that of symptoms as 
they arise. Prevention is better than cure, When the 
decompression is not too rapid there are no accidents. 
Owing to the special mechanism of the diving apparalus 
invented by M. Shidlowski, of the Russian Navy, decom- 
pression in this apparatus can only occur slowly and 
gradually. Its use has been attended by good results. 

The divers attached to the British Navy, and the men whfl 
follow diving for a living, wear a special dress and helmet' 
The dress may be either a "close" or "open" suit. The 
close suit is an air-tight indiarubbcr costume the shape of the 
body. Upon the upper part is screwed the headpiece with 
its window for seeing through. Attached to tlie headpiece is 
a conduit pi]x; for the fresh air, which is pumped in under 
pressure. By means of a valve the escape of t>ic surplus and 
foul air is provided for. The whole body is under the 
influence of compressed air ; but in the " open " suit, only the 
head of the diver is covered by a helmet screwed on to a 
jacket, and, as a consequence, the abdominal viscera may be 
exposed to considerable [jrcssure. The air escapes from 
underneath the jacket too, so that if a diver, falls his life u^J 
endangered. ^M 

Diving is now a recognised requirement in the British" 
Navy, llcforc men can become qualified as divers they must 
give evidence of having dived to the depth of 1 20 feet and have 
shown themselves capable of being able to bear a pressure of 
52 lbs. to the square inch. Apart from possible accidents 
arising through failure of the pumpcd-in air reaching the 
diver when at work, the principal danger lies in the ascent 
being made too quickly. When this has taken place, the. 



CAISSONS AND COMPRESSED AIR 113 

chanpe from a compiessed to ordinary atmospheric pressure 
has been too sudden, and, as a consequence, divers become 
unconsdoiu or are found paralysed in their extremities, hence 
the name civcn of divers' paralysis to the malady. When 
divers have been pulled up too rapidly on board of ship 
jomc of them have died, and at the post-mortem examination 
the blood in the body has bccii found to contain bubbles of 
air. The spinal cord on section has been found lacerated. 
its small blood-vessels torn and bubbles of air readily 
recognisable. 

In the Statistical Report of the Navy for 1900. Flcet- 
Surgcon Archibald McKinlay. R.N., tells of a man who 
dt\'ed for a torpedo in 34J fathoms of water at Lamlash, 
Arran. He took 40 minutes to go down, remained at the 
bottom 40 minutes, and took 20 minutes to come up. The 
Mcent was made by the seaman himself slon-ly, steadily, and 
without any hurry. He climbed up the ladder on the side of 
the boat himself On the removal of the (ace-plate of the 
helmet the diver said he felt all right. He began to give a 
detailed account of what he had done; wa.s sensible and 
cheerful and joked with the other men. About 8 minutes 
after coming out of the water he was suddenly seized with 
pain at the stomach and begged that the doctor might be 
sent for. Immediately afterwards he slid down and became 
nacotiscious. When Flcct-Surgcon McKinlay saw him he 
was comatose, "skin was cyanoscd and his breathing ster- 
torous, laboured, and diflicult His lips were blowing and 
covered with frolK" He died about 15 minutes after coming 
out of the water, />., 7 minutes after the commencement of 
his symptoms. At the po.tt-mortem examination, which was 
nude on the following day, a large quantity of dark fluid 
blood escaped from the vessels on the surface and base of the 
brain. Nothing abnormal was detected in the substance of 
the brain itself, but the veins of Galen, those on the surface 
of the brain and of the choroid plexus contained bubbles of 
air. The lungs were absolutely healthy and not the least 
engorged. The veins on the surface of the heart had a 
beaded appearance due to bubbles of air within them. On 
, opening the right ventricle of the heart air came out with a 



JI4 



DISEASES OP OCCUPATION 



puff, and internally there was found a small quantity of blao 
frothy blood. The left heart was empty; the heart itsdf 
and valves were healthy. The liver was daric and engorged ; 
on section tlie cut surface exuded large quantities of froth. 
The spleen was dark and contained frothy blood. From the 
cellular ti.<csue tn the subcutaneous fat of the body there 
escaped bubbles of air. 

This man had been working at a pressure equal to 4} 
atmospheres. It is interesting to note that two days previous 
to the occurrence of this accident another able-bodied seaman 
of the same biittlcship^H.M.S. /four — descended to exactly 
the same depth, was at the bottom for 22} minutes, took 
18 minutes to ascend, experienced no inconvenience at the 
time, and had no bad effects afterwards^ 

Recent experiments undertaken for the Admiralty lead 
Haldanc to recommend decompression in graduated stages, 
so that a "di%'cr or worker in compressed air is bronght 
rapidly to half the absolute pressure, stopped there for a 
time, then decompressed a little further after sufficient time 
has elapsed to allow the ma>cimuro nitit^cn pressure in 
his tissues to become not more than twice the nitrogen 
pressure of the air at a lower stage. He t.s then brought 
on by further stages on the same principle until he reaches 
atmospheric pressure." For diving work stage decompression 
is the superior method even when effected qitickly,-~Sctfiue 
Prtigr^ss, January, 190S, p. 389. 



I 



CHAPTER IV 



DISEASES DUE TO DIMINISHED ATMOSrilERlC PRESSURE 



ON the surface of the earth at ordinary levels man is 
living under a pressure of t; lbs. aerial pressure to 
the square inch. He is no more conscious of this weight 
than when bathing he dives a few feet below the surface of 
the water. So elastic is the vital resistance of the human 
body that man can ascend to considerable heights or descend 
to great depths without discomfort, and even without serious 
risks, so long as certain precautions are obser\-ed. There are, 
h<»w(.-vcr, limits to these attainments. The man who is 
climbing an Alpine peak has to lift hi> body a few thousand 
feet through an atmosphere that becomes rarer as he ascends, 
and as a consequence his heart beats more vigorously and 
even unplea-s.intly, and there is a sense of difficulty of 
breathing. There are added to the muscular effort of lifting 
the body through space the difficulties of getting oxygen 
into and carbonic acid out of the system. On reaching the 
immmit men have been known to bleed from the nose. 
Although it cannot be statcft that death has been caused by 
diminished atmospheric pressures at great heights, yet it has 
been shown experimentally in animals that coma is induced 
which may end in death. It is just a question how far the 
sudden supervention of cardiac and cerebral symptoms in 
mountain-climbers may not be responsible for some of the 
fatal accidents that occur from time to time on the Alps. 

Altitude modifies the ordinary functions of the body in 
many ways. Such influences are in operation, for example, 
as diminution of atmospheric pressure or of oxygen tension, 



ii6 



DISEASES OF OCCUPATION 



cold, atmospheric electricity, and luminosity. The effect 
of luminosity is not exactly known. At high altitudes 
the atmosphere is more highly chained with electricity 
than is the air of the plains. It is not known what is 
the effect of this upon the body, nor of the light of high 
altitudes, which Is rich in ultra-violet rays, the chemical 
activity of which is intense — a circumstance which, while 
explaining the frequency of the inflammatory redness of 
the skin of Alpine climbers, confers upon mountain air its 
purity and its freedom from germs. By these rays the 
air is rendered sterile. High up on a mountain-side the air 
is less dense, so that the same volume of air represents a 
smaller quantity of oxygen than in the plain. One might 
well ask, in view of this new respiratory medium, whether 
there is any change in the clKmistry of respiration. To 
answer the question it is necessary to distinguish between 
respiration in the state of repose and in movement. Accord- 
ing to Zuntz. Lowy, Mltller, and Caspari ' the number of 
respirations in a state of repose is not increased, but the 
amplitude of the respiration is augmented. The volume of 
air inspired is greater per minute, but the quantity of oxygen 
ab-sorbcd, if its volume is reduced to a pressure of 760 mm. 
of mercury, docs not vary. During muscular exercise the 
number of respirations increases. The volume of air inspired, 
and consequently the volume of o.\ygcn absorbed, reduced to 
760 mm. of mercury, is much greater at high altitudes than 
It is in the plains for the same effort. Zuntz's experiments 
offer a physiological explanation of the breathlessness that 
occurs at high altitudes. Fatigue is increased not only from 
the fact of the chest being in one sense overworked, but 
because the products of organic combustion are increased 
and the circulation of these waste products in the system is 
a cause of fatigue. Auto-inloxication due to overwork 
readily develops afler excessive exercise and betrays itself 
by insomnia and loss of appetite. It is apparent that if the 
effort which is exerted at high altitudes is greater than that 
required in tlie plains, the demand must be met by increased 

' " HOtictikliniu uiid BcrgwatKlcnrngcii In ihrer Wtrkung auf den 
Hcnwhen," Bcflin, 190$. 



n 




DIMINISHED ATMOSPHERIC PRESSURE 117 

food. less of the nature of albumins than of carbohydrates 
anti fats. At very high altitudes the quantity of oxygen in 
the air i^ Insufficient for breathing purpose;*, (n a similar 
way when men undergo too violent exercise the demand 
made by the body for ox>^n is so great that the lungs 
cannot inhale air quickly enough. The result is the same in 
the two cases. There is anoxemia, or what is sometimes 
called "le mal des mont^nes." 

Professor Mosso, of Turin University, whose work on 
" Fatigue " is well known, is rather opposed to the interpreta- 
tion of the results by Zuntz. At great heights the respiration 
occasionally takes on the Chcyne-Stokcs type, i>., a scries of 
short and rapid inspirations gradually becoming slower and 
deeper and finally ceasing for a few seconds, only for a scries 
of similar cycles to be repeated. This peculiar type of 
respiration has been attributed by Professor Mosso to a 
diminution of carbonic acid in the blood, for by giving 
inhalations of carbonic acid Cheyne-Stokes' respiration dis- 
appears. According to Mosso " le mal dcs montagiics." or 
mountain-sickness, is due to a deficiency of carbonic acid in 
the blood — a condition named by him aatpncKa. Zuntz, on 
the other hand, maintains that tlicre is sufiicicnt carbonic 
acid to the blood to excite the respiratory centre to action, 
and that inhalations of carbonic acid do not dispel the 
symptoms of mountain-sickness. Oxygen alone can do this^ 
At high altitudes man consumes more oxygen. The 
increased frequency of respirations is one of the most striking 
manifestations of the need of oxygen, and the increase in the 
Dumber of the beats of the heart is a physiological conse- 
quence. To send the oxygen all through the body the heart 
must beat faster. In repose the heart beats slowly and at 
a certain rate — say (J4 to 72 per minute — but a man has 
only to undertake a fatiguing walk for the pulse to rise 
to 120 or more per minute: Uving at high altitudes is 
difficult and trying to persons who are the subjects of 
valvular disease uf the heart. In health tlic heart and lungs 
at high altitudes adapt tbemseU'cs to the rarefaction of the 
oxygen, and the blood behaves in a similar manner. By 
degrees there is c:stablishcd an increase in the number of the 



llfi 



DISEASES OF OCCUPATION 



red corpuKlex of the blood, as well as of their coloaring 
matter or hannoglobia 

If I were to seek for an application of this physiologica] 
knowledge I could not do better than refer to the experience 
of persons who have travelled in trains at ^reat altitudes. 
Some of the mines in Peru and Bolivia axe high ap on the 
mountains. Mr. Thomas Thomson, mining engineer of the 
firm of Messrs. Tcarson and Company, London, tells me 
that in order to reach the great tableland of Pern the train 
rises i in 25 to 15,600 feet, and that at 13.500 feet mountain- 
sickness commences in the railway travellers with a sense of 
headache followed by a feeling of stckr)eS3, but there is no 
vomiting. There is a rush of blood to the head and flushing 
of the face, which travellers feel would be relieved if the nose 
would only bleed. Mr. Thomson's own pulse usually rose 
to 8S per minute and the respirations were proporttonately 
quickened. 

The men who work at the copper-mines at Ccrro dc Pasca, 
situated iC,000 feet above the sca-le^-el, cannot follow the 
occupation loi^. They can only work for a few months at a 
time, when they are obliged to cease and return lo their 
farms. The men work an eight hours* day in the mine:!. 
The influence of acclinrntisation and heredity is noteworthy. 
The native labourers, who are Spaniards or of Spanish 
descent and who liave been born at, comparatively speaking, 
high altitudes, bear the work better than other men. They 
can work Longer without breaking down in health. White 
men, Europeans, cannot work at all in these mines, but they 
can superintend the work for about a year. The ordinary 
miners do not die from the cfTects of working under these 
conditions ; thtry relinquish the work too soon for functional 
or organic disease to be established. At Ccrro de Pasca the 
miners call the mountain-sickness sorrocM. The 50 to lOO 
feet th.it the men go down into the mines has little effect 
in diminishing the effects of the great altitude already 
mentioned, vix., i6,ooo feet. 

What has been said of mountain climbing and of living 
and working at high altitudes applies to some extent to 
aeronauts. The only difference is the absence of muscular 




DIMINISHED ATMOSPHERIC PRESSURE 119 

fatigue, but against this must be placed the rapidity of 
change of atmospheric pressure. U the ascent is made very 
rapidly the system may have some difficulty in accommo- 
dAttng itself to changes of pressure. There is, too, the 
influence of exposure to greater cold. Persons ascending in 
balloons should dress warmly, and they ought to take with 
them cylinders filled with compressed oxygen. It remains 
yet to be seen what part balloons will play in military 
warfare Doth in the French and German Armies there ha%'c 
been several deaths of soldiers from poisoning by arsenlu- 
rcttcd hydrogen. The hydrogen used for inflating balloons is 
obtained by acting upon zinc with sulphuric acid, but as the 
sulphuric acid is manufactured from pyrites which fre- 
quently contains 2 to 5 per cent of arsenic, the impure 
hydrogen cannot but be inhaled during the filling of the 
balloons, and to this circumstance must be attributed the 
poisoning that occurs. The symptoms commence with a 
sense of malaise and nausea, followed later on by jaundice; 
The urine becomes dark and blood-coloured, and may 
contain albumen. Only pure hydrogen should be used for 
the purpose of inflating balloons. 



CHAPTER V 



CHEMICAL TRADES 



UNDER the heading of chemfeal trades will be Jn-I 
eluded principally the manufacture of chloride of 
lime, bleaching powder, sulphuric and hydrochloric acids. 
These are usually produced in one and the same factory ( 
as parts of one process. It is unnecessary to describe in 
detail the methods of manufacture known as the Lc 
lilanc process, the Wcldon and the Deacon process. Only a. 
brief mention is possible. In the manufacture of soda or 
salt cake common salt is acted upon by oil of vitriol 
(sulphuric acid). When these are mixed tc^ther and 
raked on the bed of a furnace large quantities of hydro- 
chloric acid are evolved, the vapour of which when breathed 
has a strong irritating influence upon the respiratory 
mucous membrane. This circumstance renders it impossible 
for the workmen to remain exposed to the vapour for any 
length of time, or to the gas which is given off when the 
salt cake thus formed is raked from the furnace into the 
barrows and wheeled away to undergo another operation 
in a difTcrent part of the factory. In order to protect 
himself from the hydrochloric acid fumes the workman 
wears folds of flannel round his face, for the acid fumes 
quickly destroy the teetli. As the woric in the furnace 
department is hot the men perspire freely, and conse- 
quently run the risk of becoming chilled and of catching 
cold. When the chemical Industry on Tyneside was more 
prosperous and gave employment to a Vdr^et number of 
persons than at present we were seldom without chemical 
labourers in the Royal Infirmary as in-patients. They 
were the subjects of chronic bronchitis with asthma and 



CHEMICAL TRADES 121 

emphysema of the lung*. The hours of the men em- 
ployed in chemical factories are long, and in their work 
they arc exposed to high temperatures. There are, there- 
fore, many inducements to the men to become intemperate 
as regards the use of alcohol. Many of the men drink 
freely, for their wages arc good. 

After the salt cake leaves the furnace it is mixed with 
limestone and coal in a black ash furnace, and after being 
heated and stirred in the furnace a sufficient length of time the 
mixture is poured out In a molten form, cooled, broken up, and 
the soda dissolved out from it This soda may be converted 
into soda-ash, soda crystals, or caustic soda. For the produc- 
tion of caustic soda the operations required involve boiling, 
fumacing, and other processes. When the caustic soda is 
in solution in large iron cauldrons and is hot it is apt to 
spurt and caux serious burns. In order to prepare bleaching 
powder slaked time munt be exposed to the freshly prepared 
chlorine gas obtained from hydrochloric acid given off during 
the operations at the salt-cake furnace. For a bleaching 
powder to be successful it ought to be capable of retaining 
j8 per cent, of chlorine gas. This is not readily secured ; 
besides, when it is obtained the bleaching powder keeps 
constantly parting with its chlorine. Ulcaching powder with 
less than 35 per cent, of chlorine does not sell well. It is, 
thereibre, most important for the manufacturers to succeed in 
obtaining the extra 2 or 3 per cent, of chlorine. In the 
manufacture of bleaching powder by the Weldon process 
there is always a high percentage of chlorine present tn the 
gas, and the method of manufacture is slightly difTcrcnt. 
Urac is spread upon the lead Hour uf large chambers, into 
which chlorine gas is passed. The doors arc closed for three 
days, during which chlorine enters. The gas is absorbed. 
When the conversion uf the iimc into bleaching powder has 
been effected workmen enter the chamber. The mouth is 
irotected by several rolls of flannel, but the nostrils nre free. 
Iher goggles are worn to protect the eyes. The men 
shovel the powder through holes in the floor into casks under- 
neath. The packing of the bleach is an unpleasant occupa- 
tion. The men wearing the rotht uf flannel round their face 



Kprot 

t sbo\ 




122 



DISEASES OF OCCUPATION 






take care to breathe through the mouth, and only allow 
expired air to escape through the nostrils. Thus protected, 
and accustomed to breathe in the manner stated, a man nay 
be able to stay in a bleach chamber for twenty minutes 
to half an hour or longer, during which time he is shovelling 
the bleach powder, but it is desirable that the workman 
should corae out of the chamber into the open air every half 
hour and stay outside a short time before returning. 

Most of us arc familiar with the odour of chlorincL The 
gas has not only an irritating effect upon the respiratory 
mucous membrane, which may continue for several d&ys, but 
it may also cause vomiting. Jn what is called the "gassing" 
of chemical workers, the symptoms are irritation of the 
bronchial tubes, a feeling of suffocation, and vomiting, 
symptoms fortunately of temporary duration, but which tf 
often repeated may lead to stnictuntl alterations of tl 
bronchial tubes and emphysema of the lungs. 

Sul])huric acid is usually manufactured in the same 
chemical factories as soda. Sulphur, or sulphide of iron, is 
burned with the liberation of sulphuretted hydrogen. This 
gas is carried away into lead chambers, where it is brought 
into contact with air, steam, and nitrous fumes obtained 
by acting upon sodium nitrate with sulphuric acid. Although 
this is not such a hard occupation as the making of salt cake, 
the men who work at the pyrites furnace where the sulphur is 
given off arc exposed to some extent to sulphur dioxide and 
to occasional nitrous fumes. These gases arc irritating to 
the respiratory mucous membranes, and have much 
same effect as chlorine and hydrochloric acid. 

The Le Blanc process has had a lengthened career, but 
soda and chlorine can be produced by other methods, such 
as the electrolysis of salt. The passage of an electric 
current through salt solution breaks up the salt into 
chlorine and caustic soda, and when this decomposition 
has been effected the liberated chlorine can be ied away 
for the purpose of making bleaching powder. Methods of 
manufacture die hard. There are indications that so long 
as there is tlie grxrat demand for salt cake for making g 
the Lc Blanc process will probably continue. 



to. 




CHEMICAL TRADES 

Electrolytic methods arc, however, gradually making pro* 
gress in the manufactures, for by them there ts uften a saving 
of time. They arc not always free from risk to health. In 
the manufacture of chloride of calcium, also of chloride of 
sodium and potassium by electrolysis, a peculiar skin eruption 
appears on the workmen. This dermatitis, which has only 
been detected during tlie last six or seven years, was first 
noticed among the men employed at Griezheira Factory in 
Germany. Since then the workmen employed at Motte- 
Breuil, in France, have also suffered. The malady Is attri- 
buted to the hypochlorite of soda that is formed. The 
dermatitis usually affects young workers who have been in 
the factory a few days or weeks. It commences on the face 
by a crop of acne spots, and is attended by redness and 
cedcma recalling erj'sipclns. The redness and swelling arc 
pretty evenly distributed all over the face ; the lobule of the 
cars is implicated and the eyelids are aidcmatous. Once 
the dermatitis has obtaine<l a thorough hold the eruption 
may last for as long as fifteen days, and in disap|>caring 
leaves behind a few hard nodules and comedones on the 
skin. The swollen eyelids frequently become itchy and 
secrete a thin, purulent liquid, while the whites of the e>'es 
becomes red and ctdcmatous. Cough with laryngeal and 
bronchial irritation may be present There is dys|>epHia 
with loss of appetite. Emaciation is progressive, and there 
b extreme muscular and nervous debility. So marked is the 
tendency to sleep that many of the patients can hardly keep 
awake. The best treatment is the open air. As preventives, 
the ventilation of the factory should be good ; the men 
ahould freely use soap, and wash in water acidulated with 
•ulphurtc acid, before leaving work. The application of 
vasdine to the unprotected parts of the body when at work 
is also well worthy of a trial. 

Taking chemical workers as a whole it may be said that 
tiie younger men are not an unhealthy class. They become 
bronchitic and asthmatic as tlicy grow older, and this too at 
■ comparatively early age. Chemical workers on the whole 
enjoy good health until the age of 35, but after this the 
death-rate rises so that by the time they reach the ages of 45 



124 



DISEASES OF OCCUPATION 



to SS the mortality rate of chemical workers is double tha^ 
men who follow an out-door occupation. Diseases of the 
respiratory system contribute largely to the high death-rate. 

Nitrous and Nitric Atid Pumtt 

In the process known as "carotting" in the manufact 
of felt hats from rabbits' sltins the teeth of the work< 
become much affected {vide article "Mercury"). The skin 
is stretched upon a bench, and rubbed vigorously by the men, 
who keep dipping their brushes into a solution of nitrate of 
mercury. Occasionally the workmen make their own solution 
of mercur>' by dissolving 8 parts of quicksilver in 64 of 
nitric acid and then adding 4 of arsenic and 4 of corrosiw 
sublimate. In preparing the solution the nitrous vapours 
that are evolved cause considerable cough and irritation of 
the lining membrane of the bronchi and lungs, and this maj 
sow the seeds of future pulmonary trouble. 

The acid fumes arc of themselves dangerous. I can 
the occasion of a large iire in a chemical stores in 
castle, when one of tlic firemen who were exposed to the 
nitrons and nitric fumes died a few days afterwards from a 
peculiar form of inflammation of the lungs. Most of the 
serious cases of nitric acid poisoning have arisen from acci- 
dental breathing of gases containing fumes. In chemical 
factories the men who work at the pyrites burners, in 
addition to being exposed to heat and cold, are brought into 
contact with sulphur dioxide, nitrous fumes, and other gases, 
all of them more or \^sa irritating to the throat and lungs. 
Men employed in the manufacture of arsenic, arseniatc of 
soda, picric acid, and in the manufacture of jewellery, 
especially the refining of the precious metals, are occasionally 
brought into contact with the fumes of nitric acid, but in a 
large proportion of the cases in which poisoning by fumes 
has taken place it has been through the accidental and 
unexpected escape of the vapour, inhalation of which causes 
cough, dryness of the throat, :ind sense of sufTocalion. A 
man who has inadvertently inhaled the fumes of nitrous 
nitric acid may not exhibit any symptoms imt 



s may 1 

Neva 



les 01 nitrous o^ 



CHEMICAL TRADES 



"5 



yet within from 24 to 48 hours he dies from acute con- 
gc5tion of the lungs, preceded by an abundant expectoration 
of thin, yellow materia). The intelligence is retained to the 
last At the post-mortem examination of the body the 
lungs arc found to be intensely congested ; there may be 
patches of reddish brown discoloration, in other words a 
patchy distribution of congestion which is always suggestive 
of the action of a toxic gas. The blood that is squeezed 
from the lungs is blackish brovn. Nitrogen peroxide (NO3) 
is clearly, therefore, a strong and dangerous irritant to the 
bronchial and pulmonary mucoiis membranes. It produces 
sniall foci of pulmonary congesticm, and it causes the blood 
to become of a deep brown colour. The treatment — and it 
is seldom successful—'is to overcome the painful condition of 
the throat and windpipe by the use of soothing gargles, 
and the bronchitis and pneumonia by the inhalation of 

r 



Anilitie 



In the black dyeing of al paca goods, aniline oil, when acted 
npon by hydrochloric acid, gives off fumes which cause the 
workmen to be ill. This method of dyeing cotton goods 
has been, in consequence, almost entirely abandoned. 
Aniline salt, which is obtained from aniline oil and is a 
dirty yellnw-white crystalline substance, is instead usually 
mixed with the hydrochloric acid. In the Manchester 
factories the solutions used are aniltiK salt, prussiate of soda, 
and chlorate of soda as an oxidising agent The cotton web, 
after passing through a trough containing the solution, 
travels onwards through a long, heated chamber. At this 
particular stage of the dyeing the men frequently suffer from 
the great heat and from the dust that is given off from the 
cloth. This part of the machinery ought to be protected 
by a hood, up which there should be a strong draught of 
air. The cotton cloth does not at once become black on 
being passed through the solution, but as it travels onwards 
it becomes black by exposure. The cloth, in travelling 
through an oven of indigo and steam, undergoes what is 
known as " ageing." From tliis it passes through a solution 




136 



DISEASES OF OCCUPATION 






of bichromate of soda It is after receiving this i 
that the black colour becomes fixed in thccloth. < 
ining the hands of the men who work at the bichromate 
trough I have not fuiind evitieiicc of any induration of the 
skin or of cracks upon their hands. The colour can be 6x 
by such other substances as tannin and tartar emetic, 
one of the lai^c dyeworks near Paris which I had the oppor- 
tunity of visiting the process was slightly different The 
cotton web passed first through a solution of aniline salts, 
and after travelling a short distance passed through a second 
bath containing chromatc of soda. Afterwards it kept 
moving onwards through hot chambers to be dried. Where 
more expensive aniline dyed poods are wanted the eotton, 
after its dip in the aniline salt dilution, travels onwards 
through a heated chamber, and in doini; so the cloth be- 
comes olive green in colour through oxidation by the hot air. 
It is then dipped in the chromatc bath and dried, 
product thus obtained is said to be more durable than 
got by the first method. 

In what is called fittra rif// dyeing, the ingredients U: 
frequently cause symptoms similar to those induced 
aniline oil. The men exiierience headache, become sick, a 
arc mildly intoxicated. They have to be taken out into th 
fresh air. The para red powder used in English dyewor' 
is a proprietary chemical c mpound obtained from German; 
The men who mix this material in the dyeworks, as 
as those who throw the plastic stufT upon the cloth, suAer. 
The former arc obliged, when scooping out the dry p<»wder 
from the cisks, to wear respirators, I'ara red is usctl for 
dyeing flannelette, which is nothing eliie than cotton cloth, 
one surface of which has been picked by sharp points and 
caused to be fluffy like flannel, but in which there is 
rK> wool at all As I have mentioned flannelette, I need 
only add tliat it is an extremely inflammable substance 
and as it is cheap and freiiuently forms the underwear and 
nightdresses of children, it has been, and still is, eveiy year, 
unfortunately, the cause of death of large numbers 
children by their garments catching Arc. 

The symptoms of aniline poisoning are headache, drowsi* 
ncss, a feeling of sickness with loss of appetite, shortness of 



"4 

an<r^ 
s th^j 



4 




llh, palpitation, antl a tingling wnsation in the feet and 
legs. Dr. Walter Maiden * on examining the blood of aniline 
workers did not find that it gave the spectrum of met- 
haemoglobin, but this is not surpriKing, as the band of 
met-hxnioglobin can hardly be detected unless this sub* 
stance is present In at least the proportion of i to lO 
of oxy-lvemoglobin. Nor was there evidence of blood 
destruction to any extent, judging from the fact that the 
blood counts showed a normal average of red corpuscles. 
The colouring matter was reduced in amount, but the 
pfoportion of white corpuscles was not excessive. Maiden 
is of the opinion that if there is a destruction of red 
corpuscles in aniline poisoning it is counter-balanced by a 
renovation of corpuscles, which, as it proceeds more rapidly 
than the formation of hxmoglobin, causes the colour index 
to be lower than in health, while the presence of basophil granu- 
lations in the red corpuscles points to imperfect formation of 
these cells or su^ests that they are undergoing degeneration. 
The health of workers in aniline has of late years much im- 
proved. During the summer months the workmen arc apt to 
suffer most. The severe headache, vertigo, and sickness may 
not come on until they have left the factory and reached home. 
Attention has frequently been drawn to the sudden develop- 
ment of rather alarming symptoms, especially in young 
children, the cause of which for a long time was obscure, but 
which is now known to be the use of a liquid rich in aniline oil 
for polishing the brown and fawn coloured boots and shoes 
that are so much worn at present. Children, when out 
walking with their nurses, have become rapidly blue in the 
face (cyanosed), the subjects of cliflficulty of breathing and of 
extreme muscular debility followed by somnolence. The 
symptom.'! occasionally assume a serious aspect, and the 
patients for the time being are really very 111 owing to the 
poisoned condition of the blood. Exposure to the fresh air 
is, on the whole, the best treatment. The occurrence of these 
alarming symptoms has been generally traced to the use of 
a boot polish containing aniline oil. 

Relm,' a German surgeon, has drawn attention to the 

■ The Journal of Hygiene, October, 1907. 

' " Berliner Klinische Woclienscbrift," vol. li.. No. 19. 



128 



DISEASES OF OCCtWATION 



occurrence of twenty-one cases of tumour in the blaxld 
among men employed in aniline works. Some of the mi 
had worked 29 years — others only 5 >-ears. The tumoura 
were of a papillomatous or warty type in 3 of the men ; in 
1 8 tlie growths were sarcom-itous or carcinomatous. Owing 
to the malignant nature of most of the ];rowihs, it of the 
patients had died at the time Rclm published his paper. 



Nitro and Di-nilro- Benzene ; Di-nitro-Bensot 



« 



Owing to the odour of bitter almonds given off by nitro- 
benzene, this substance is made use of in the manufacture of 
perfumery and in cooking. 1 1 is also uKcd in the manufacture 
of aniline. Workers in nitro-benzol factories are liable to 
attacks of giddiness and of unconsciousness, accompanied by 
blueness of the face or cyanosis. Inhalation of air mixed with 
nitro-benzol induces difficulty of breathing, and obliges the 
workmen to Iea\-e the factory and go out of doors. In the 
chronic form of poisoning there are headache, dizziness, and 
temporary loss of consciousness with cyanosis, symptoms 
which dis%p]}ear when the men keep olf work for a few daya, 
provided they leave their working clothes behind them in the 
factory. Return to work is frajucntly followed by a reap* 
pcanince of symptoms. The urine is dark, and the men are 
overcome by a desire to sleep. Muscular pains are com- 
plained of, and fatigue is readily induced. The eyesight is 
frequently aflccted. On examining the urine, traces of 
di-nitro-betiicne will be found therein. In chronic cases of 
poisoning the di -nitro- benzene breaks up the red coiposcles 
of the blood, and alters its colour from a bright red to a 
chocolate brown. Maiden ' found di-nitro-bcnzcnc to be 
more toxic to the workmen than aniline and that the first 
recognisable sign in the blood of poisoning by di-nitro- benzol 
is the presence of basophil granulations tn the red blood 
corpuscles followed by a diminution in the number of the 
corpuscles by 1 to ij| millions per cmm. of blood, 
found in chronic cases an increase in the number of whi 
corpuscles, especially lymphocytes, also in the more severe 
' Tkt journal (^ Hyiitne, October, it)07. 



the , 



CHEMICAL TRADES 



i»9 



forms of poisoning a few nucleated red corpuscles and a trace 
of met-hsemuglobin as revealed by the »p<:ctroscopc. 

Benzene is converted into nitro and di-nitro- benzene, or 
myrbanc. by the action of sulphuric and nitric add. 
Myrbane is reduced to aniline by hydrocliloric add and 
iron. 

In the maniiracture of some of thehigh explosives, naphtha- 
lene and the aromatic nuclei, bcnzciic and toluene, arc made 
use of. The higher the nitration of the aromatic bodies ts 
carried, the more dangerous becomes the manipulation of 
these substances. Di- nitro- benzene is a powerful poison, 
whether inhaled, swallowed, or injected into the circulation. 

Dr. Prosscr White, of Wigan, in " Dangerous Trades " gives 
a very full account of poisoning by di -nitro- benzene. When 
ordinary precautions are taken by the workmen, there 19 
little risk to health. The workrooms must be well ventilated. 
It is desirable that the factory should be situated in the 
country. Cleanliness of the workroom and personal cleanli- 
ness of the men are requisites. Handling of the com- 
pounds should be avoided m far as possible, and everything 
done automatically and in cloaed-in machinery. Washing 
appliances and towels with soap should be ample. The 
temperature of the workroom should be kept low and dry, 
since moisture is usually followed by increase of sickness. 
In the winter months it is noticed that the amount of sickness 
usually declines. The workmen should wear sjxxrifil clothing 
and caps, and as the dust is liable to be deposited on the hair 
of the head and on the beard, it is better for the men to be 
clean shaven and for the hair to be worn short. There 
should be a medical inspection once a week, and all new 
bands should be medically examined before being allowed to 
work. As it is work that women sometimes follow, ana:mia 
should be regarded as disqualifying. A similar remark 
applies to pregnancy. When symptom.-s of poisoning occur, 
the workpeople should be taken out of the factory into the 
open air, and if the cyanosis is well marked, it may be neces- 
sary to resort to the inhalation of oxygen, the application 
of warmth to the extremities, and the introduction of warm 
drinks by the mouth or rectum. 



CHAPTER VI 

EXPLOSIVES AND THE EFFECTS UPON HEALTH OP 
THE CASES EVOLVED 



BV the term " explosives " is meant substances, solid 
liquid, which through the chemical action induced ii 
tliem by the application of heat or some other cause." 
become rapidly converted into gases which occupy a n>uc1l, 
greater volume than theori^nal substance, and which become 
subsequently still further expanded by the enormous heat re-' 
suiting from the chemical reaction. All kinds of ammunition 
are included under this designation,^^., gunpowder, nitro- 
glycerine, dynamite, gun-cotton, blastinu powder, fulminate of 
mercury, &c. The chemical reactions that occur arc explosion 
reactions. Once started in an explosion the reaction is pro- 
pagated from molecule to molecule throughout the mass, and 
as the rate of the rapidity of this propagation varies between 
wide limits, it produces ordinary eomhuslion when it pro- 
gresses slowly, an fsfl/o<ria» when it is relatively very rapid. 
and dtfonation when its velocity is almost infinite. These 
terms, however, are relative, for no bard and fast rule can be 
drau-n between Ihcm, since in many instances the same explo- 
sive under different physical or mechanical conditions, or 
diflTerently confined or ignited, may develop any of ilicse 
phenomena. In order to produce their full effects, explosit-es 
of the gunpowder type require to be strongly confined, where- 
as with Uie more violent types of explosives, such as gun- 
cotton and nitro-glycerine, the degree of confinement can be 
very much less. An explosive reaction may be induced by 
frktion or percussion, by contact with a heated or ignited 
body or by using a sensitive composition ignitabic by pcrcus- 



EXPLOSIVES AND THEIR EFFECTS 131 



aioa or friction, and which in turn igniter Uie explosive. The 
eflect produced varies with the particular manner in which the 
explosive reaction 15 induced. By the percussion of a stnall 
quantity of fulminate of mercury imbedded in nitro-glycerine 
or gun-cotton, an effect is produced which is much greater 
than the ordinary explosion of either substance itself. There 
is the almost instantaneous conversion of the whole mass of 
the explosive into £^ or vapour. To this mode of explosioD. 
as already stated, the term d^lanatian is applied. Generally 
speakinjir an explosion is a form of combn!,tion. but detona- 
tion cannot be explained quite in the same way. Heat alone 
will not produce detonation, a sudden shock is also required. 
Detonation is the effect produced by combined chemical and 
dynamical reaction. 

According to the purposes for which they arc employed 
explosives arc called A/^A and low, but these tcrm^ are 
purely relative. In Aigh explosives the chemical trans- 
forcnation is very rapid and energetic: they are usually 
fired by detonation, and the effect is more or less local. 
High explatives contain a large pca-centage of oxygen, and 
are usually definite chemical compounds. When the chemical 
reactions arc transmitted comparatively slowly through the 
maas the eflect produced is a propulsive one and the sub- 
stances employed are called lotu explosives. Propulsive 
explosives arc employed to impart motion to projectiles 
so that they travel with great rapidity through the air. 
For the purpose of oar immediate inquiry it is with the 
"disruptive" c-xplosives, or those which arc used in mines 
and quarries and which produce crusJiing or shattering 
effects, that we are mostly concerned. 

Explosive compounds contain carbon, hydrogen, oxyijcn, 
and nitrogen, the last named being always fccWy combined 
with the oxygen in whole or in part It is this instability 
of chemical equilibrium that is so essential, for when an 
explosion occurs the nitrogen molecule " readily parts with 
its oxygen to the carbon and hydrogen, for which it has a 
great affinity, forming carbonic ,icid, carbon monoxide gas, 

id water."' ' The hydrogen produces by its combustion an 
' "Treatise of Service Explosives," i9c6. 





13* 



DISEASES OF OCCUPATION 



cxtrcmdy high temperature, so that the water which is pro- 
duced is in the form of greatly expanded steam. 

GuHp&juder has during the last five centuries of its use il 
Europe varied Itttle in its coiT))K)«itton. It is a compount 
of saltpetre, charcoal, and sulphur. It is not the manu>1 
facture of gunpowder that concerns us, but the gases that 
are formed after its cxplo.tton and the effects of those ^ases 
upon men working in mines and quarries. During the 
decade ending 1S99 there occurred the following number 
of accidents in the handlinfi and use of the various 
explosives ("Dangerous Trades," p, 605): — 



Nttm of KsplmitT. 




Kanbct ( 
Kilted. 


InjDKd. 


Gunpowder 

Nitroglycerine compounds 
AmRiunium nitnlet 

Delonaiors 

Fireworlts 


»44 
376 

44 
143 

4t 


94 

'35 
11 

3 

»9 


994 
440 

^■ 

»93 
96 


Total 


848 


.63 


1,064 


Total in manufacture during same 
period 


<IS 


44 


,t^ 



Until recent years gunpowder was extensively used as an 
explosive in British coal-mines owing to its comparatively 
slow action, but it is deficient in oxygen, and should the 
carbon which it contains be only partially burned carbon 
monoxide is formed. The amount of carbon monoxide 
formed varies from 2*4 per cent upwards. The drawback! 
to the use of gunpowder in coal-mines are the heavy odour 
of sulphur that remains after the firing, also the smoke am 
development of carbon monoxide. 

Gun-cotton, discovered by a German chemist, Schonbein, 



1^ 




-OSIVES AND THEIR EFFECTS 133 



I 



In 1S46. has been proposed as a substitute for gunpowder 
owing to the fact that it possesses the power of burning 
without creating smoke and without leaving any residue. 
The explosive is prepared by immersing carded cotton in 
strong nitric acid and then carefully washing it. So many 
fatal accidents and explosions occurred during its manipula- 
tion that for several years the manufacture of gun-cotton was 
abandoned, but by removal of the free acid or any nitro- 
genous material that might be present there have been 
fewer accidents. Gun-cotton has neither smell nor taste. 
It retains the appearance of the cotton from which it Is 
made, only it is slightly harsher to the touch. 

Nitro-glyeerine. discovered in 1847 by an Italian chemist, 
A. Sobrcro. of Turin, remained more or less a chemical 
curiosity until the well-known Swedish engineer, Alfred 
Nobel, began to manufacture it in large quantities for 
blasting purposes. For years it met with very limited 
success. After long research and many experiments Nobel 
succeeded in mixing nitro-glyccrinc with an inert substance, 
kifselgvkr, a [lorous infusoria! cirth, which rendered it less 
sensitive and enabled it to be transported with safety. This 
compound is known as dynamitf, Uy substituting for the 
kieselguhr an active explosive like nitro-cotton another 
explosive is obtained, viz., bUtsting gttalint. When blasting 
gelatine is frozen It is much more liable to be exploded 
by a blow. It is a more powerful explosive than dynamite. 
From mixtures of nitro-glyccrine and soluble nilro-celiulose 
baltastiie and cordite are obtained. 

Fure niiro-glycerine is a clear, heavy, oily liquid, almost 
colourless, without smell at ordinary temperature, and with 
a sweet taste: When inhaled its vapour causes intense head- 
ache, which exposure to the fresh air or a cup of strong 
black coffee usually relieves. Nitro-glycerine can be easily 
detonated by friction or percussion. The readiest method 
gf detonating it is by a fulminate percussion cap. It is not 
easily ignited by a flame. 

T<mite consists of gun-cotton and nitrate of barium in 
almost equal proportions. 

LydJiU is obtained from picric acid. The stories that 




»34 



DISEASES OF OCCUPATION 



were in circulation at the time of the South Arrican War 
as to the destructive effects upon the enemy of the explosion 
of lyddite shells and of the poisonous character of the fumes 
that were liberated were much exa^cratcd. The lyddite 
shells when they exploded threw up great clouds of sand 
and stones and produced a greenish-yellow smoke. At 
Faardeburg the shells exploded harmlessly in the mud 
on the soft banks of the river in which the enemy had 
burrowed. "The whole of Cronje's laager was mapped out 
with great yellow patches of picric acid powder, but few 
casualties were attributable to lyddite." At Bcrgcndal, an 
irregular kopje of rocks protected by earthworks, the 
Johannesburg Zarps made a good stand. Lyddite shells 
were rained upon the place until it became untenable. On 
the third day the Boers hurriedly Bed from the position, 
leaving twelve dead and a few men wounded. One of the 
prisoners sf ^mcd at first as if he had jaundice — the skin of 
his face and hands was of a bright yellow colour, and he was 
labouring under intense nervous fear. In a few days all hisj 
nervous s)'mptoms had disappeared. Lyddite appears to' 
have little destructive effect in the open, but in a confined 
space its effects can be extremely severe. 



Accidents in tkt Manufacture and Use of Expkiivts 

There is no industry in which the possibility of sudden^ 
death and complete annihilation is greater than in the 
manufacture of explosives, and yet the number of victims 
claimed by Uie industry is fortunately small. Legislation 
has accomplished much. The men and women employed 
in explosives factories belong to the better class of work- 
people. Knowledge of the dangerous nature of their callii^ 
causes them to exercise the greatest care and cleanliness. 
Major Cooper Key, H.M. Inspector of Explosives, tells 
us in " Dangerous Trades," p. 602, that there arc 1 1,098 
persons employed in this country in the manufacture of 
explosives. During 1899 there were 54 accidents in the 
factories, in which 5 persons uxrc killed and 24 injured. 
The deaths per 1,000 persons employed in the manufacture 



EXPLOSIVES AND THEIR EPPECTS IJS 

of explosives for the ten years ending 1899 are given by 
Major Cooper Key as follows : — 





Killed. 


tnjufcd. 


<Cnnpoirdei 


S' 


t*3 


Nitro^]«erinc 


■43 


■*4 


Ammunition, exclusive of 1 






dctonaton ... ... } 


'i 


3'3 


FulminAle Composition ... ' 






Rrcwoiks 


■77 


2-9 



While death by accident in the manuf»cture of explosives 
is po-isible, there is no danf^er to the health of the operativesL 
la the manufacture of nitro-glyccrtnc the persons employed 
often suffer from head.iche for the first few days on com- 
mencing work. With renewed experience this tends to 
disappear, but will reappear should the individual absent 
himself from work for a few weeks. The women who mix 
the kicselguhr and nitro-glycerine, although they must 
ab»>Tb nitn>-gl)xerine, do not seem to suffer to any extent. 

Accidents occur during the storage of explosives, but it is 
during their use that accidents are more likely to happen, for 
familiarity in this instance too often seems to breed contempt. 
Particularly is this the case in mining. During 1S99 there 
were no less than 39 perM>ns killed in mines .md 195 persons 
injured by explosives. Several of the accidents were due to 
men scraping out the detonators with pins, thawing dynamite 
over the fire, driving dynamite and gunpowder into roughly 
drilled holes, and boring out misfires. 

Setting aside these accidents, many of which are the result 
of carelessness, wc have to deal with the effects upon miners 
working in confined spaces of the gAsc5 liberated during 
detonation. Many of the miners complain of violent head- 
ache and vomiting. They suffer from palpitation of the 
heart, become more or less collapsed, and only recover after 
they have been taken into the fresh air. When brought to 
bank the men arc pale and look ill, Soon the symptoms pass 



136 



DISEASES OF OCCUPATION 



off, especially if vomiting has taken place, but In many 
instances the patients have to be taken home, put to bed, 
given warm drinks, and have warmth applied extemally. 
Many of the miners whom I have examined a few days or i 
weeks after the "gassing" have been the subjects of ex- 1 
treme nervousness and of a sense of dread attended by want ' 
of confidence in themselves. Inhalation of the fumes given 
off by those high explosives disturbs the nervous mechanism 
of the heart. The beat of the heart is excessively rapid, and 
the men complain of unpleasant sensations in the precordial 
region. Some of the men arc more liable to be affected than 
others. There is an idiosyncrasy to the fumes given off 
during an explosion of nitro compounds. No doubt some of 
the men have themselves to blame for becoming gassed, as 
they return to the particular part of the mine too soon after 
the explosives have been fired, and time is not given for the I 
fumes to be cleared away. ' 

In the manufacture o{ futmitutie of memtry tYtert is the 
double danger of inhaling harmful emanations and the risk of 
explosion. On the addition of alcohol to a solution of »eid 
nitrate of mercury, there is produced in the liquid mass con- 
>t{derable seething, during which there rises the vapour of 
nitrous ether. It is this vapour which, on account of its 
ready inflammability, has been the cause of numerous 6res 
and which exercises upon the men who breathe it a harmful 
influence, for the workmen complain of severe headache 
coming on suddenly, vertigo, loss of consciousness, numbness 
of the extremities, and a sense of constriction of the chest 
which may be accompanied by cyanosis. 



CHAPTER Vn 
DISEASES DUE TO UETALUC POISONS, DUST, FUHKS, ETC 

IXDDmiKs IK wiiirii Ijuii IK KMPmveii :— Lhad Poisomikg ; Saturhihi 

PoiSOKINC; Tluubi^M; PAtMTKas' Couc 



Cctural Rtvitw of the Subjtcl 

THE evil effects of lead have been known for centuries. 
More deaths have been caused by lead than by any 
other metal, partly because no other metal enters so largely 
into the arts and Industries as lead, also because of the silent 
and insidious manner in which the poisoning occurs. Lead 
exerts its malign influence with a rapidity and severity greater 
in young persons than in old. Young adults especially are 
quickly brought under its sway. As a form of industrial 
poisoning it is met with among persons who inhale the dust 
and fume, who manipulate soluble lead compounds, or 
handle the metal itself. Metallic lead ptr se has less 
poisoning power than its salts, and of its compounds the most 
important in this respect arc the carbonate, oxide, and chro- 
mate, because these are most employed in the industries. 
The death-rate from lead poisoning, directly and indirectly, 
is high. As an indirect cause of death the association of 
the two is not always recognised. Usually it is easy to 
diagnose plumbism in its early stages, when it presents such 
sytnptotDS as colic and is accompanied by the presence of a 
blue line on the gums, but as a cause of chronic ill-health, 
disease of internal organs, and slowly developed structural 
changes in the nervous system, the relationship may not in 
many instances even be suspected. The evil effects of lead 
powoning arc often widely spread through a community, for 



138 



DISEASES OF OCCUPATION 






owing to the u3c of lead pipes for conveying drinking-water 
into dwelling houses, the use o( lead cisterns for storing water, 
the cooking of food (n lead enamelled utensils, the consump- 
tion of tinned meats and fruits frequently contaminated by 
the lead dissolved out of the solder, also the tar^ge number of 
industries in which lead in one form or another is made use 
of, the metal and its compoimds have many opportunities of^fl 
exerting their harmful influence upon mail. V 

Plurabism the result of drinking contaminated water and 
consuming tinned food does not come within the scope of this 
articlu. All that need be said of tliis part of Uie subject — and 
the remark applies to lead poisoning generally — is that the 
metal, when taken into the system in small quantities and in 
a soluble form for a period, operates so insidiously that the 
individual, hardly conscious of the gradual loss of healthy' 
ultimately feels that his health and strength have become so 
undermined that he can no longer work, or without any 
warning he is suddenly seized with acute abdominal pain 
with a paralysis that persists for weeks or months. 

Owing to foreign competition and the greater richness of 
foreign ores in stiver, lead mining in England ts no longer 
the source of wealth or of industrial activity of bygone days, 
and as a consequence fewer men are employed in the mines 
than formerly. With certain foreign ores it pays the British 
smelter to extract the silver and treat the lead as a by-product. 
The lead-miner docs not sufler from phimbism owing to the 
fact that the ore contains lead in almost a pure metallic sta 
but at the Broken Hill mines in Australia thcorc contains lead 
in the form of carbonate, and several of the miners there have 
died from saturnine encephalopathy, or the cerebral type 
lead poisoniiiK attended by convulsions. I^cad is also found in 
nature in the form of sulphate. It is an intere:>ting fact that at 
the Broken Hill mines, owing to the fumes from the smelting 
furnaces, the vegetation in the immediate neighbourhood is 
scanty and ill-grown, and that the common fowls which pick 
their way about the grounds a large proportion die from lead 
poisoning. Dr. Mncdiarmid, who has been living at the lead 
mines at Linares. Spain, informs mc that fowl-keepers in that 
district complain of the hens laying eggs without a Rrm 




METALLIC POISONS. DUST, FUMES, ETC. 139 



V 



supporting shell. I have nc^'er succeeded tn producing this 
tendency in hens, although, like other animals, they can be 
readily poisoned b)' lead. Fowb lose the pou-er of ivalking, 
they stagger a good deal and frequently fail, and their urine 
contains albumen. In lead-smelting districts, e-g., Leadhills 
in Scotland and in the dales of County Durham, the fumes 
frofD the furnaces poison the pasturage of the ncighbourhcxxi, 
and cattle grazing thereon have died from lead poisotiing. 
At BIcJberg, in Belgium, I found the same accidents had 
happened, and that the owners of the works had had to pay 
heavy compensation to the farmers for the loss of their cattle. 
While hatching fowls in an incubator I found that if a portion 
of a hen's egg is painted with a neutral solution of lead acetate 
development of the chick is arretted and on opening the egg 
that the embryo is dead. Fainting the surface of other egfirs 
in a similar way with a strong solution of lime is not attended 
by death of the embryo. While lead is dcBtructive to the 
higher forms of life, it is not so to all of the lower forms. In 
an interesting paper on the " Immunity of Some I^w Forms 
of Life from Lead Poisoning," Mr. T. W. Hogg' gives the 
results of a series of examinations which he made on earth- 
worms which inhabited a waste bark heap in a lai^c lead 
works. The heap consists chiefly of the old bark taken from 
the white lead stacks with sweepings from the yards, and 
amounts to 20,cxx> tons, as it is tlie accumulation of over 
lixty years. The bark is impregnated with lead, varying 
from i'5 to 3'5 per cent., umt away from the surface it is in a 
damp, pulpy condition. To a great extent it has become 
converted into a kind of vegetable mould. Notwithstanding 
the lai^ amount of lead present in the bark, the waste heap 
in the summer months teems with animal life, especially 
with the common earthworm. The bark contains nutritive 
material. In the intestines of the worms there is usually 
found a conMcierablc quantity of finely divided bark, so that 
when worms are desiccated and dried at loCP C. the quantity 
of lead found corresponds closely with that present in the bark 
itself. Earthworms consist approximately of 80 per cent of 
water and 20 per cent of organic and mineral matter. Hogg 
Socivty of Chemical Industry. Newcastle Section, \fcbtxi2ty 38, 1895. 




140 



DISEASES OP OCCUPATION 



found that the amount of lead, estimated as lead protoxi' 
present in the organisms varied from 037 to 0'52 per cent 
This is a targe quantity of lead, but when the intestines were 
freed from their contents and thoroughly washed the amounts 
varied from 0009 to 0018 ixrr cent, a circumstance which 
shows that only very small traces were retained in the cel- 
lular lininfj of the alimentary canal. Although an extremely 
small quantity, even this amount of lead is greater than that 
which is found in the internal organs of men and women who 
have died from industrial lead ]>oi&oning. Professor Bcdson, 
of the Armstrong College of Science, made for me several 
analyscsof the brain, liver, and kidneys of male and female 
lead workers who died under my care in the Newcastle Infirm- 
ary, and while the largest amount of lead was usually found 
in the liver, the proportion present in the grey matter of tl 
brain was in some instances only 0*00053 per cent Hogg o 
microscopically examining earthworms treated with a solu*] 
Uon of ammonium sulphide found that the only part of t 
body which became dark and therefore showed the prcsen< 
of lead was the intestinal wall. Beyond that the metal did 
not appear to pass. An interesting question therefore arises 
as to how it is that earthworms possess an immunity to lead. 
The answer is probably to be found in the operation of their 
calciferous glands. On squeezing out the secretion of these 
glands and treating it with ammonium sulphide no trace of lead 
was detected. How this secretion should offcrany protection 
it is difficult to say. When serving with Professor Thorpe on 
the I'ollery Commission we learned that there was an opinion 
widely held by the workmen in Staffordshire that those 
who drank a particular ale did not suffer from plumbism. 
In this ale Professor Thorpe found a fairly lai^ percentage 
of sulphate of calcium. That calcium sails confer immunity. 
I am not prepared to say. In the pottery worker the im^ 
munity above referred to is probably rather the result 
of slow absorption, owing to the conversion of soluble lead 
compounds in the alimentary canal into the less soluble 
lead sulphate, than of any real protection that is afforded. 
Darwin estimated that a single worm ejected 20 ounces of. 
soil per year. Given the same immunity from lead poisonin 



'4 




METALLIC POISONS, DUST, FUMES, ETC. 141 



that possessed by an earthworm weighing 22 to 25 grains, 

man would be able to swallow annually several times 

lis own weight of white lead, and to retain continually one 

'pound of it in his system without exhibiting symptoms of 

poisoning. It may be that this immunity of the earthworm 

is part of a resistance begotten by successive generations 

or it is an illustration of 3 similar power which otlier orf^n- 

istns possess of growing luxuriantly in poisonous media, as 

witness certain moulds in arsenical and mercuric solutions, 

also of the power which certain birds possess of eating the 

^^dcadly strychnos nux vomica with impunity. 

^^^K Ltad Mining: Sftulting: Desilverisitig 

^^B Lead miners do not in this country suffer from lead 
^^joisoning. but, as the mines are badly ventilated, are often 
wet, and entrance into and exit from them can only be effected 
by means of ladders, the men suffer in their general health and 
from rheumatism. In the dales of Durham, house accom- 
modation near the lead mines is difficult to obtain. Con- 
sequently many of the men have long distances to walk from 
and to home. At the end of a day's work, when heated and 
fatigued, tliey are tlius exposed in winter to the cold winds 
that sweep along the valleys. Bronchitis and lung diseases 
claim a large number of victims. The deadliest enemy is tuber- 
culosis. Formerly, when lead mining wa<i more of an industrial 
success than it is to-day, the men were housed in barracks 
close to the mines, and returned to their homes at the week- 
ends. These barracks were overcrowded and badly venti- 
lated, and were hotbeds of tuberculosis. In the sleeping- 
rooms not only u-as the air space insufficient and the beds too 
I close to each other, but the windows were never opene<l, and 
^hniners who were Uie subjects of bronchial catarrh and 
^tuberculous lung disease simply expectorated on the floor of 
the dormitories. Overcrowding, the breathing of foul air and 
of the dust-laden atmosphere of the sleeping-rooms favoured 
the spread of tuberculosis. As a consequence of these and of 
exposure to severe weather, also inattention to " colds on the 
chest," lead miners, although living in healthy districts, have 



142 



DISEASES OF OCCUPATION 



succtimbcd to phthisis in much larjijcr numbers than other 
persons living in the same district 

So far as industrial plumbism is concerned, the danger to 
heaUh commences with the smelting of the lead ore. During 
the year 1906, 38 cases of lead poisoning occurred in smelting 
works, 24 of which were in lead works. The fumes which are 
given off, if not carried away from the face of the workmen, 
arc apt to cause poisoning. Since furnacemen therefore run 
considerable risk, all furnaces should be hooded. The fumes 
are often caused to travel a great distance through dues, 
often high enough for a man to stand in them, and some- 
times half a mile in length, before being allowed to escape. 
From each ton of metallic lead that is smelted 130 lbs. 
of lead will be given off as fume. It is the fume from 
lead-smelting furnaces which poisons the pasturage and 
causes the death of cows and sheep that graze on the 
fields in the neighbourhood. Smelters occasionally sufTer 
from lead poisoning and its con5C(]Ucncc — kidney disease. 
There is an idiosyncrasy to plumbism, more marked in some 
persons tliaii in others. I have known member after 
member of a family — all strong, healthy young men who 
had been employed as smelters — die from lead poisoning and 
its sequeUe, while their comrades escaped. Animals are 
rapidly destroyed by fiuc dust. The cleaning out of the 
flues is a most dangerous occupation, for the dust is nearly all 
oxide and sulphate of lead, and unless the passages are freely 
ventilated men cannot work in them for more than two hours 
at a stretch without suffering from severe headache and 
becoming generally ill. After cleaning out the flues the men 
should luve a warm bath. 

Instead of allowing lead thus to escape, which is a loss to 
the manufacturer, the fumes could be passed through water 
under pressure, and much of the lead thereby recovered. It is 
impo.ssiblc to recover by rapid methods all the lead. At the 
Mies Works, in Austria, the fumes, after passing through 
leaden chambers to be cooled, pass on through fifty chambo^ 
which arc kept wet with spraysof water in order to precipitate 
the lead and absorb the suli^ur. From these chambers the 
fumes are led through wooden tubes and through a portion 



^ 




METALLIC POISONS, DUST, FUMES, ETC. 143 

a disused mine. Notwithstanding all this attempt to 
ccyvcr the lead, the fumes on escaping arc futind to contain 
14 per cent, of sulphur .ind 4 per cent, of lead. At other 
works the liquid from the spray chambers is piisscd over 
limestone, whereby the sulphur and any arsenic tliat may be 
pre.sent are absorbed and the lead precipitated in the Hme, 
from which it is obtained by drying. 

Since lead contains a fairly large quantity of silver, this 
has to be extracted by means of making an amalgam of lead 
with iinc in the molten state. This method of desilverising, 
which is known as the Pattinson proces.s, is not attended by 
lead poisoning to any great extent ; still, I have met with cases 
of plumbism in de^ilvercrs. A fatal case of plumbism in a 
dcsilvercr wa.s reported to the Home Office in 1 906. Although 
the men are exposed to high temperatures, and the ladling out 
of the molten metal is rather laborious work, yet it cannot be 
said that the men — generally a better class of workmen — 
suffer as much as the nature of their employment might 
lead one to expect. The melting down of old scrap lead, 
tea lead, old lead pipe^, &c, is attended \nth greater risk to 
health than the use of the pure metal, partly because proper 
preeauttons as regards hoo<ling of tlic melting pot;; and 
ventilation arc not taken, the amount of fume is considerable, 
and there is more litharge (oxide of lead) dust raised during 
the ladling of the molten metal, 



Hed Lead: Litharge, Massicot. Lead Oxide 

In the manufacture of red lead the metal is simply roasted 
in a reverberatory furnace and raked from time to time. A 
considerable amount of fume escapes from the mouth of the 
furnace, and unless this is hooded and a strong draught pro- 
vided to carry it away, the workmen may become poisoned. 
The red lead is removed in large pieces, placed in barrows.and 
allowed to cool. It rcf)uircs seven to eight hours to convert 
tnetvllic lead into litharge. During the grinding of red lead 
large quantities of fine dust are raised. To inhalation of the 
dust, as well as to the fumes, must be attributed the symptoms 
of plumbism met with in the workmen. Red lead workers 



144 



DISEASES OF OCCUPATION 



am 



form from I to 2 per cent, of all the cases of plumbtsi 
reported to the Home Office. 

When litharge which has been washed and dried is again 
placed in the furnace, roasted afresh, and raked so as b 
become further oxidised, it is converted into what is kno' 
as yellow litharge. 

In red lead works the furnaces are placed along one side 
the building, but itwould be an advantage to havethem in the 
centreof the room. 90 that men could walk round the furnaces; 
to have the building lit from above and not at the sides, and to 
have the roof high and the walls smooth, so that as little dust 
as possible might collect upon them. The floors should be 
made of cement or bricks, and not, as in too many instances, 
the ordioary soil. Iron Boors arc objectionable on account 
of their sltpperiness. The advantage of cement floors is that 
they can be bru^ihed or swilled with the hose. In England 
most of the walls of red lead factories arc rough and begrimed 
with dust ; in Germany the rt^ulations are that the wall^f 
shall be painted, so that they can be washed ; while in Austrut^ 
two whitewashings per annum are regarded as sufficient. 
Young adults should not be allowed to work in white lead 
works nor in the red lead furnace, grinding, and packing 1 
departments, nor ought women to be employed therein. j 

A few years ago at Klagenfiirt White Lead Works, in 
Austria, during a period of scarcity of adult labour, the 
men begged the employers to allow thdr sons to work in 
the factory. Lads under eighteen years of age were con- 
sequently given employment. These youths, all of them of 
good physique, well-developed, at)d healthy looking, were 
examined medically before entering the factory, and yet, 
notwithstanding this precaution, .so grent was the amount of 
lead poisoning amongst them, and in such a short time, too, 
that the employers were obliged to dismiss them. 



LOO, , 

tcfl 



The use of tobacco under any form should be prohibit 
in the factory. Disregard of this regulation should be visited \ 
by a penalty. There should be a special room set aside for 
the clothes of the workmen. In Great Britain the wear- 
ing of overalls in dusty departments is re<iuired, but in 
Austria a Commission which sat in Vienna In 1905 recom- 



METALLIC POISONS, DUST, FUMES, ETC. 145 



I 



"^ineiidcd the provision of three suits of clothes,(i) forordlnaiy 
use, (2) for cleaning pur|K)se$, and (3) for reserve. The re- 
commendation of the Austrian Committee could hardly be 
carried out in England, owing to the large amount of casual 
bhour in Ii:a<l facturicK. Ijoth in white and red lead works I 
have always been in favour of alternation of employment, ie., 
the undesirability of allowint:! workmen to remain too long 
in dangerous departments, and the gain to health obtained 
by fthtfting them from inside to outside work, and vut 
vtrsd, has been considerable. I have seen the advantages 
of this in the large white lead works of Messrs. Ivxpcrt 
Besan^n & Cie., in Paris, where the men follow out a 
scheme of alternate emptoyment. The registers of Messrs. 
]lcsan(;on's factory contain a carefully kept bit^raphical 
account of each workman and of the number of weeks 
spent in each particular department, .so that years after- 
wards, by referring to the register, information is at once 
obtained as to what a workman was doing on a particular 
date. One of the efTects of supplanting hand labour by 
machinery is that, as fewer hands are required, it is more dtffi- 
colt to carry out alternate employment. The wearing of a 
simple moist respirator, fixed by a band round the head, is a 
safeguard in dusty processes. It has been recommended that 
an apparatus should be worn such as that used in mines after 
an explosion or in places containing foul air. If this were to 
be adopted a simpler and less expensive form of apparatus 
Id have to be invented. Too great stress cannot be laid 
upon the necessity for personal cleanliness. It is the want of 
personal cleanliness which makes casual labour in lead works 
more dangerous than constant employroeoL In England and 

I'Scotland white lead workers arc taken from the poorest and 
most indigent classes: many of them, having lost Ihcir regular 
employment through intemperance, gladly seek work in lead 
factories, but they arc not lit subjects for the occupation. 
Allusion has been made to the provision of clothes for the men 
when in the factory. These clothes — blouses and loose trousers 
narrowed at the foot — ought to be washed regularly once a 
week, and the washing should be done by machinery. I have 
known several instances of women whose duty it was to wash 




>46 



DISEASES OF OCCUPATION 



the clothes of the workmen employed in lead factories losing 
the power in their hands and sufTcring from acute lead poison- 
ing. Bath-rooms should be provided at the works, otherwise 
it Is impossible for the men to have a warm bath, owing to the 
poor condition of their homes. The men should be obliged 
to take a bath at least once a week, oftener if they have been 
eng^ed in dusty processes. Washing the hands in water 
containing a small quantity of acetic acid and various forms 
of .^ap have been recommended. What is required is 
cleanliness, even to the removal of the dust from underneath 
the 6ngcr-nails. Unsatisfactory as the lead industry is from a 
health point of view, much good has been effected in recent 
years by enforcing the regulations and by the monthly medical 
examination of the workers, with power given to the factory 
surgeon to suspend when necessary. This examination is 
shirked by several of the employiis, and especially by the 
casual workers, to whom tbe shilling fee is a matter of some 
mportancc. Where the medical examination has been 
systematically carried out nothing but good has resulted, 
but even this procedure does not confer complete immunity, 
for experience shoAvs that workers who have passed the 
doctor and who have been pronounced as satisfactory have 
the same day been taken ill witli symptoms of acute 
plumbism. 

LeaJ ttduttries. ManHfacture o/ Wkiti Lead 

Kotwitlistanding the progress of science and the improve- 
ments in modern industrial methods, poisoning by lead and 
its compounds continues to be a disconcerting fact to legis- 
lators, a dis.ippointment to employers, and a source of ill- 
bcalth to a large number of the working classes. Reference 
has already been made to the insidious manner in which 
plumbism develops. It cannot be too strongly asserted that 
some of the worst types of lead poisoning arc more frequently 
the result of the daily entrance into the system of minute 
quantities of lead than of large doses. This is probably due 
to the fact that lead in minute quantities is more likely to be 
absorbed, and is an explanation of the fact that by the time 
symptoms develop the workman has already received into his 



4 

4 



METALLIC POISONS, DUST, FUMES, ETC. 14? 

fiystem a fair quantity of the metal or its salts. Attempts have 
been made to underestimate the amount of industml lead 
poisoning. and to attribute a share of the plumbism in certain 
manufacturing districts to women swallowing diachylon pills 
for the purpose of procuring abortion, while by other writers 
al of the accidents of saturnism ha\'e been regarded 
as the outcome of indulgence in alcohol. In my Goulstunian 
lectures on lead poisoning I give the results of a scries of 
experiments upon animals, to which alcohol as well as lead 
was administered in the food, and it was conclusively demon- 
strated that alcc^ol precipitated attacks of plumbism, a fact 
which in the human subject clinical experience has again 
and again confirmed. There is not the least doubt that 
alcoholic intemperance predisposes to lead poisoning, in a 
lead worker, who is also the subject of alcobolbm, it is not 
always easy to differentiate between the symptoms caused by 
aJcohol and those due to lead. In consequence of this fact 
^Hthere has been among certain writers a disposition to as-sign 
to intemperate habits a special rdic in the development of 
symptoms which, unless due care is taken, may mislead, 
since the symptoms may, aller all, be the result of occupa- 
tion. Double wrist-droji is one of the common phenomena 
of lead poisoning ; on the other hand, par&ly^s of the feet 
arKl legs is of frequent development in chronic alcoholism, the 
wrists Usually being spared. Occasionally, however, these 
may suffer. The nerves selected and the muscles affected 
are in thetwo formsof poisoning quitedistinct, and yet incon- 
sequence of loss of power in the hands in white lead workers 
and house- painters it is sometimes stated that the men 
following these avocations are more intemperate than others 
of the working classes. With no wish to brand one class of 
workmen as intemperate compared with nnother, the habits 
of the working classes of different districts are interesting 
in regard to lead poisoning. In a Report on the white lead 
industry presented lu the French Senate by M. Trcille a 
marked difference is shown to exist between the northern 
and southern divisions of France. The intemperate habits 
of tbe working classes of Normandy and Brittany arc well 
known. These two districts give employment to one-third 



-HJ U ltf- 



148 



DISEASES OF OCCUPATION 



of the total number of house-painters in France, and 
within their borders the death-rate from plumbism 1* 
more than one-half that of France. Chronic cases of lead' 
poisoning arc much more prevalent in the north than in the 
south. Normandy alone with its heavy consumption of 
alcohol has more than one-h»1f of the total cases of lead 
paralysis in France. The infltwrice of alcohol in these 
cases, as in all, is to reduce the vital resistance of the nerve 
cells of the workman, to render him careless as to the; 
necessity for cleanliness, and thereby to render him mem 
prone to plumbism. Another circumstance which predisposes 
to lead poisoning is working in lead before having breakfasted. 
If there is one fact which the experiments carried out on 
my behalf by Professor Bedson demonstrate, it is that if 
food is present in the stomach at the time a workman com- 
mence-s work in a while lead factory in the monitng.he runs 
much less risk of lead poisoning than his comrade who goes 
to the factory without having broken his fast Owners 
white lead factories would not only be doing a humane act, 
but rendering an economic service, if they provided their 
hands with hot coffee, tea, or milk and bread before com- 
mencing work in the early morning. 

The prevalence of lead poisoning in Great Britain and 
Treland, and the influence exerted by Home Oflioe regula- 
tions and medical inspection may be seen from the table on 
page 149, extracted from the Annual Report of the Chief 
Inspector of Factories for the year 1906. 

There has been a discontinuous diminution in the number 
of cases of industrial lead poisoning since 1899, and in no 
branch of industry Is this more apparent than in the manu- 
facture of white lead. It was largely on my recommendation 
— when a member of the White Lead Commission — that the 
Home Office by regulations abolished female labour in the dan- 
gerous processes of white lead manufacture. Although the 
recommendation was opposed at the time by almost every 
white lead manufacturer in the country on economic grounds 
as well as those customarily connected with the trade, em- 
ployers now admit that nothing has so purified the lead in- 
dustry of what was to them a source of worry and a cause ol 



I 



M 




METALLIC POISONS, DUST, FUMES, ETC. 149 

tfiscatisfaction to the public as the retnovnl of women from the 
stripping of the white beds, washing of the white le<id, filling 
and emptying of the stoves, and other dangerous processes of 
manufacture. Notwithstanding the exclusion of women from 
work in the white beds of a white lead factory, there is still a 
lar^e number of women employed in tbe works, whose condi- 
tioo. Miss Faterson, H.M. I nspector of Factories, tells us, calls 
for constant supervision. Manufacturers arc not considering 
their own interests, nor the reputation of the trade, when 
they employ females in the factor^'. Knowing bow ex- 



Dteae a^ taavtry. 


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White lead 


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trecnely prone women are to lead poisoning, it is not with 
astonishment wc team that plumbism is still frequently 
observed amongst women employed in such subsidiary pro- 
cesses in white lead works as dusting and washing the 
"ackl" pots removed from the white beds and the dry 
carbonate boxes from the stoves. I have seen young women 
flic from acute lead encephalopathy within four months after 
commencing work in a white lead factory. In a case 
reported by Miss Paterson ■ the girl had worked less than 

■ "Annual Report of the Chief Inspector of factories for 1906,'' 

p. 313. 





ISO 



DISEASES OF OCCUPATION 



twn months when she became the subject of plumtMsm. 
Employers cannot be too frequently reminded that the 
susceptibility of females to lead poisoning is greater than 
that of males, and that the symptoms are usually of a 
graver character. Apart from the influence of sex, women's 
wages are smaller, and they are therefore less able, iT] 
fighting tlie battle of life alone, to obtain proper food, 
which, as already stated, is a protection to some extent 
against ptumtMsm. 

Formerly Newcastle and T>'neside were hotbeds of indus- 
trial lead poisoning. To-day cases of phimbism arc few and 
far between. Until the crusade against lead poisoning there 
was hardly a week passed without patients thus affected 
seeking advice at the Royal Inlirmar)', and scarcely a 
month went by without there appearing in the daily press 
the announcement of the death of a lead worker, usually 
a young female. All this is changed. It is a rare event 
to have in our Infirmary wards a patient suffering from 
industrial lead poisoning, and especially a feinulc in- 
patient. The declension in the number of cases of indus- 
trial plumbism has taken place without a reduction in 
the total number of persons employed. In 1892 there 
were 44 patients admitted into the Royal Infirmary, New- 
castle-upon-Tyne — 15 males and 27 females ; in igoo 
there were 14 patients, all males; since 1900 it has been a 
rare event to have even one patient the subject of industrial 
lead poisoning. 

It was in 1898 that the Home Office abolished female 
labour in the dangerous processes of white lead manufacture. 
Until that date there is not the least doubt that females 
had been employed In larger numbers than males in the 
dangerous processes ; but, apart from this circumstance, 
females are more prone to plumbism than males. This 
applies pretty generally to the female sex of all anlmak 
In addition to sexual proclivity to plumbism, there Is a 
family and individual idiosyncrasy to it as well. Members 
of some families are more predis(>osed to lead poisoning 
than uthers. 

In order to appreciate the diflTcrencc in the df^rcc of 



METALLIC POISONS, DUST, FUMES, ETC. 151 



danger to health in some procci^se!! of white lead manufacture 
compared witli others, the methods of manufacture may be 
briefly described. Most of the white lead sold in this country 
is made by the old Dutch process, which consists in the trans- 
formation of metallic lead into the white carbonate by a slow 
and double process of conversion. Numerous earthenware 
pots, containing 3 per cent, of acetic acid, are placcrd on tan 
in a large threc-walled chamber, and upon these pots are laid 
thin strips of metallic lead, and subsequently planks of wood. 
Tier after tier of pots, resting on bark and covered with metallic 
lead and wood, are thus superimposed until the chamber, 25 
to 30 feet in height, is filled to within 6 feet from the top. 
This chamber, known as the " blue " bed, is now closed in front 
by wooden planks or doors, and kept closed for fourteen 
weeks or longer. Fermentation occurs in the blue beds, the 
temperature rises, and carbonic acid is evolved from the 
bark, escape of the excess of which is provided for at 
the top. The acetic acid vapour acts upon the lead and 
converts it into acetate of lead, while the carbonic acid 
evolved from the bark changes the acetate into carbonate, 
the well-known white lead of commerce. Usually there is 
little danger run by persons employed in making up a blue 
bed, and yet a little while ago in one factory there were 
eleven out of twelve cases in women who had inhaled the dust. 
It is when the conversion of the metallic lead into carbonate 
has occurred that the first danger in the manufacture is en- 
countered. This occurs during theempt)'ing or stripping of 
what is now called the " white " bed, and if sufficient time has 
not been given fur the very soluble acetate to have become 
changed into the carbonate the danger is thereby greater. 
The white beds should not be disturbed until the conversion 
is complete, nor should men be allowctl to empty the white 
beds as piece work, as they arc sure to hurry over the task, 
careless in regard to raising dust and heedless of the necessity 
of spraying with water. 

Durit^ the stripping of the white beds there is a consider- 
able quantity of dust raised, a large part of which is white 
lead, and unless spraying with water is efTectually carried 
out the workers cannot avoid inhaling the dust. Formerly 




15* 



DISEASES OF OCCUPATION 



the stripping of the white beds was mostly done by female 
labour, but on account of the lai^e amount of sickness 
among the women so employed the work had to be aban- 
doned. In emptying a white bed the lead carbonate is 
found as a thick white incrustation on the metallic lead, 
for ail the metal is not completely converted. This is picked 
off and conveyed to the wash tubs, where it is put through 
rollers and washed. The material is collected, placed in jars 
or boxes, and subsequently carried to the " stove," a chamber 
composed of shelves, and upon which the jars containing the 
washed white lead arc deposited. When filled the door of 
the stove or drying chamber is closed, and the temperature 
gradually raised to 70" C, and kept thus for fort)'-cight 
hours. The temperature of the stove must not be raised 
too quickly, otherwise some of the lead carbonate will be 
changed into lead oxide, as shown by the presence of a 
delicate pink colour. In two days the stove, after having 
cooled down, is emptied. Afiei its removal the white lead Is 
ground and mixed with oil to make paint, or it is packed 
into casks and sold as dry white lead. The filling of the 
barrels is a dusty process, and ought to be carried on in a 
closed chamber freely ventilated. 

The drawing of the stove is a dangerous process, and ought 
not to be undertaken until the temperature has fallen. In 
removing the jars filled with dry white lead there is a con- 
siderable amount of dust rai.'ied. It is work for which women 
are ill-suited on account of their dress raising dust, and yet 
tlie drawing or emptying of stoves was, until 1S98, almost 
entirely cfTccled by females. ! have known healthy young 
women, after a few days' work in the stoves, so completely 
abaltered in health as to be obliged to relinquish the work 
pennaocntly. 

Knowing the proclivity of women to plumbism, I have 
always felt that ! was justified from a medical and social point 
of view in having pressed for the abolition of female labour in 
the white beds, stoves, and the dusty processes of white lead 
manufacture ; and while at the time I was much abused for 
my pains, it is gratif>nng to know that, by excluding women 
from these processes, death has been averted, much human 




METALLIC POISONS. DUST, FUMES, ETC. 153 



suflcring spared, and that there has not been the dislocation 
in the trade employers feared, nor the difficulty of obtaining 
male labour, which was advanced as a reason gainst the 
change. As bearing upon the greater danger to health 
in some processes of Uie manufacture compared with others, 
the figures of the Medical Inspector of Factories are of 
interest Between January and October, 1898, there were 
reported to the Home Office 191 cases of lead poisoning. 
Of these the stoves supplied 76 patients and stripping of 
white beds 31. The ages of the patients were: — 

Under 20 ycarv 10-jo. 3f>~A°- 40-50. 50-to. Over fo. 
7 84 58 24 15 I 

In four-fifths of the total ca-ses the malady took the form 
of colic, and in the remaining one-fiftb there were paralysis 
and ocrcbral sympioms. On February 17, 1898, the Home 
Secretary (Sir M. White Ridley) announced in the House of 
Commons that there had been 37 cases of lead poisoning 
in factories and lead works among boy? under 18 years 
of age which had proved fatal. Work in a white lead 
factory is not an occupation for young persons of either sex : 
the employment of young persons has consequently been 
largely discontinued. It is interesting to know that neither 
dogs nor cats can live in a white lead factory. Machinery 
is replacing hand labour in white lead works. Formerly 
women could be seen carrying on their head at a time 
£rom one department in the factory to another two or 
three boxes filled with white lead, also one box under each 
arm. All this has, fortunately, been abolished. The work is 
done by mechanical means, and with good results, as will be 
mentioned later on. 

Much of the danger in white lead works is explained by 
the circumstance that, since most of the work is unskilled, 
considerable dcpendMiee has to be placed upon casual labour. 
This, with irregularity of employment, is an clement in the 
(problem of industrial plumbi.sm that must not be overlooked. 
Men who arc regularly employed in a white lead factory 
know the dangers to health, and while admitting that 
even with them familiarity often breeds contempt, still 




>54 



DISEASES OF OCCUPATION 



these men, notwithstanding their lengthened service, are less 
frequently ill than newcomers who do not appreciate the 
danger. Dr. T. Morison LcRge found that of i ,463 persons 
employed off and on in white lead works, the incidence of 
lead poisoning was 6 per cent of the average number regu- 
larly employed, and in those casually employed 39 per cenL 
Out of 13 factories with regular employ mcnt. 4 had no 
cases of plumbism to report, even although in one of these 
factories 1 10 persons were employed ; wherea.* from two 
factories in which there was a large amount of casual 
employment 50 cases of phimbism were reported. This is 
quite in keeping with my own hospital experience. The 
lai^^t number of patients admitte(i into tlie Newcastle 
Infirmary always came from one particular factory — one, too, 
not always employing the largest number of hands. The 
explanation is not difficult. Apart from greater structural 
defects in one factory compared with another, also mure lax 
supervision of the workers and de5cient provision of washing 
appUanccs, the fiersonite/ of iht: workers is of some importance, 
for casual labourers are careless in their habits and wanting 
in personal cleanliness, they frequently indulge in alcohol 
to excess, they chew tobacco when at work, and as many of 
them have been out of work for some time the>' have not had 
the means to obtain proper food. These, singly and com* 
bined, predispose to industrial lead poisoning. 

It is unnecessary to detail other processes of white lead 
manufacture, since they arc not made use of to any extent in 
this country. In the chamber process acetic acid is placed 
on the floor and strips of metallic lead are suspended on 
wooden frames ; the carbonic acid is obtained from bum* 
ing coke and is con^-cyed directly into the chamber, the 
windows and door of which arc hcrmeticaUy sealed. In 
eight or ten weeks the conversion is complete. In this 
method the use of tan is done away with, but there is 
the same danger incurred in removing tlic lead carbonate 
from these ch-imbers as in stripping the white beds^ Spray- 
ing with water is necessary. The precipitation process 
of white lead manufacture calls for only the briefest de- 
scription, ft is made use of in France, where it is known 



4 



METALLIC POISONS, DUST. FUMES, ETC. 155 



'bs Thenard's methoi) or white lead manufacture. Basic 
acetate of lead is first formed. This is subsequently de- 
composed by means of carbonic acid, but the white lead 
thus produced is not amorphous, and is aljoRcther an in- 
ferior product compared with that obtained by the Dutch 
method. In America white lead is made by electrolysis. 
Nitrate of soda is decomposed by electrolysis in presence of 
a lead salt. Nitrate uf lead is the result This is acted upon 
by means of caustic soda so as to form lead hydroxide. By 
acting upon the hydroxide with sodium bicarbonate white 
lead is obtained, but it has inferior covering powers, and is 
too crystalline compared with that produced by slower 
methods. In this country there i^ a strong feeling in favour 
of white lead made by the old Dutch method. Since it is 
generally rt^arded as a finer product, it usually commands a 
higher price. 

So far as the manufacture of white lead is concerned, the 
processes that arc d3ngerou.s to the ivorkpeople are those in 
which the atmosphere is dusty, for the dust, being mostly 
white lead, is dthcr stvallowcd or inhaled. If swallowed, the 
white lead is converted in the stomach, by the hydrochloric 
acid of the gastric juice, into a soluble chloride which is 
readily absorbed into the blood ; if inhaled, the dust is 
deposited in the alkaline mucus secreted by the respiratory 
pas-sagcs and absorbed. Lead may also be absorbed through 
the skin, as we know from the use of hair dyes a.nd oint- 
ments containing lead : also through open wounds on the 
skin. Dust is the enemy to be avoided by the white lead 
worker. It is raised in the stripping of the white beds, 
emptying of the stoves, and in packing. Spraying with 
water, by allaying the du-i^t in the white bed.s, has rendered 
this process less dangerous, the filling and emptying of 
stoves by mechanical means has robbed the stoves of much 
of their danger, while improved methods of packing, but 
especially the immediate transference of the white lead from 
the white beds to the mixing department, where tt is ground, 
washed with water, and subsequently mixed with oil, and 
thus converted into paint straightaway, without ever having 
been handled at all, has rendered the manufacture of white 



»56 



DISEASES OF OCCUPATION 



lead and paint a much less harmful indostry than it ua 
to be. 

In white paint there Is, on an average, 75 per cent 
of lead carbonate and 25 per cent, of oil. Before it is 
used house-painters frequently add to it a small quantity of 
turpentine, or a little oil with some drying agent, such 
borate or oxalate of magnesia or burnt alum. The men 
who mix the paint do not suffer to any extent from 
plumbism. They do not handle the compounds, but simply^ 
lift the Rnished product with wooden »pade<i. The wet 
processes connected with white lead manufacture and its 
compounds arc, comparatively speaking, but not entirely,! 
free from danger, as the subjoined Rgures show. In two 
white lead factories the workers who suffered from plumbism. 
werc made up as follows : — 





No.«rc^«». 


. 

PciCtnt. 


SlripfMng white beds 
Making up blue beds 
Packing dry white lead ... 
Paint mills 

Casting 

Stoves 




4* 

10 

'7 

10 

8 


t9'0 

15*8 

1 1-7 

S'5 



In these factories the stoves had been so modified as toj 
have removed much of the danger incidental to the work 
.carried on therein. That the stoves and white beds can 
be the cause of lead poisoning to a greater extent than 
other processes is shown by the following figures obtained 
fivm H.M. Medical Inspector of Factories of 192 cases of 
plumbism : — 

Stoves in coDjunction with white beds and rollere ... 
White beds alone or in conjunction with blue beds ... 

Rollers 

Labourers 

Indefinite 



METALLIC POISONS, DUST. FUMES, ETC. 157 



1." 



Since dust is tite enemy to be avoided, the workpeople 
are recommended to wear respirators. That respirators 
entangle a considerable quantity of dust was shown by the 
late Dr. Dupr^ during the sitting of the White Lead Com- 
mission, also by Mr. Rogers. H.M. Inspector of Factoricss, 
v^o found in the respiratont worn by persons working in a 
yam dyeworks 0-0054 gramme of lead when the fans were 
running and the atmosphere fairly free, and when the fans 
had been stopped 0x32 gramme. There does not appear to 
be any particular season of the year during which the 
number of cases of lead poisoning is greater than in 
another. 

In no works, from a health point of view, arc the good 
^ects of spending money on fresh plant more apparent than 
In white lead factories. It has been, and still is, in some places 
the practice for boxes of white lead to be carried by the 
workpeople from one department of the factory to another, 
e^.,fTom the white beds to the wash-tubs and stoves. This is 
not only a slow method of transit, but a dusty one as well. 
Mechanical lifters and carriers worked by electricity are used 

many factories with greater safety as regards the health 
of the workpeople and saving as to time and labour. By 
such means, as well as by mechanical stoves having 
supplanted hand labour, the gain effected has been consider- 
able. In the factory of the Union Miniire dc Bleiberg the 
Tiumber of cases of plumbism fell, as a consequence of this 
substitution, from 55*2 to 19*1 over a period of ten years, 
although the production of lead compounds bad more than 
doubled ; and in the white lead works of Newcastle-upon- 
Tyne equally satisfactory results have followed the intro* 
duction of mechanical lifters and carriers. 




Martufa^ture of China and Earthnnoarg 

' Next to the white and red lead industries, the trade which 
gives the lai^est number of victims of plumbism is that of 
china and earthenware. The manufacture of pottery is a 
good illustration of how an industry becomes rooted in a 

'district Nine-tenths of the china and earthenware produced 



158 



DISEASES OF OCCUPATION 



in England are made in Staflbrilshire, espectallyin the towns 
of Sloke-on-Trcnt. Burslcm, Hanley, Longton, Kenton, and 
Tunstall, collectively spoken of as the " Potteries," and yet th 
finer ctay from which the earthenware is made has all disap^' 
peared from Stafford shire. The coal, however, remains, and 
cheap fuel is an element in the manufacture of pottery that 
cannot be ignored. At the present time the fine clay has to 
be brought from Cornwall. The manufacture of pottery in 
StafTordshire is an old industry ; it goes back more than two 
hundred years. At that date clay was plentiful in the neigh- 
bourhood. The «-are was made from yellow or red marl, and 
glazed with galena, a crushed raw lead ore brought froi 
Derbyshire. In i6So common salt was subustitutcd for 
galena in the glaze. In 1739 Wedgwood improved the 
manufacture of white cream ware, and introduced the green, 
black Egyptian, and jasiier wares. Since then the produc- 
tion of pottery in Staffordshire has gone up by leaps and 
bounds. Staffordshire has supplied more of tbe world's 
markets with china and earthenware than the pottery dis- 
tricts of any other country. She feels the kccnncs.<i of 
modern competition, and is stniggting hard to maintain the 
supremacy. Upwards of 70,000 tons of ball clay are annually 
delivered into the " Potteries " from the south of England. 
Kaolin, the Chinese word for the clay out of which porcelain 
is made, is in Staffordshire called china, or Corntsh clay, and 
is obtained from ground granite. It is unnecessary to 
describe at length the manufacture of pottery. Suffice it to 
say that, so far as domestic ware is concerned, once it is 
shaped or moulded it is placed in the oven and fired. The 
ware is then known as biscuit. Some ware, such as terra- 
cotta and stoneware, requires only one firing, but all other 
ware has to be fired twice. Previous to the second firing it 
Is dipped into a liquid glaze, which usually contains a quan 
tity of lead. The lead in the glaze may be the ordinary 
carbonate, i.e., white lead, or the lend compound may first 
have been fired with other substances and vitrified. This 
gives it the appearance of glass, and renders the lead more 
insoluble. The lead in this form is spoken of as having been 
"fritted." When ground and mixed with fine clay and waterit 



6r^ 



.^ 




METALLIC POISON'S, DUST, FUMES, ETC. 159 



I 



brms a white liquid like chalk, and ts a safer glaze for the 
workmen than the glaze made from raw lead. By the term 
** fritted lead " is meant a compound of raw lead (carbonate^ 
silica, and boric acid, &c., fused together at a high temperature 
The resulting product is extremely hard, and is sparingly 
soluble in acids. Into the glaze, no matter how made, the 
ware is dipped. When dried, each piece is smoothed and 
cleaned. Where the gtase contains only raw lead, the dust 
which is given off during the cleaning of the ware contains a 
large quantityof lead carbonate, and as the dipper'sassistants 
cannot bui inhale some of the dust, this is one of the dangerous 
processes of earthenware manufacture, for many of the hands 
thus employed suffer from lead poisoning. Once the ware 
has been smoothed it is carefully packed in sabers, large 
coarse earthenware dishes, and placed in the oven to undergo 
a second firing. Owing to the high temperature the glaze 
on the surface of the dipped article melts, and gives, when 
cooled, the gloss seen upon cups, saucers, plates, &c. 

China or porcelain differs somewhat from earthenware. 
The porcelain manufactured in Limoges, France, is made 
from kaolin, felspar, and quartz ; a softer kind is made at 
S^res, near Paris ; white in England porcelain is made from 
kaolin and Cornish stone, with calcined bone added to it. 
Pot hard porcelain the glaze is made from felspar, in which 
there is always some quartz, while for other kinds of porcelain 
the glaze usually contains silicate of lead and borax. The 
presence of lead in any glaze allows of a lower temperature 
being used Ibr the biscuited ware, and thereby of a saving of 
fuel being effected. 

Roughly speaking, there arc fifty thousand persons em- 
ployed in Staffordshire in the manufacture of china and 
earthenware. Ten years ago the large number of cases of 
lead poisoning in the " Potteries " created a good deal of 
public interest and dissatisfaction, which found vent in such 
hostile criticism that the subject was discussed in Parliament 
The Home Secretary appointed Professor Thorpe, of the 
Government Latxiratory, and myself in May. (898, to make 
a special inquiry into the matter, and to ascertain — 

" I. How far the danger may be diminished or removed by 




i6o 



DISEASES OF OCCUPATION 



substituting for the carbonate of lead ordinarily used either' 
(a) one or other less soluble compound of lead, f.g., a silicate; 
(fi) Icadlcss glaze. 

" 2. How far any substitutes found to be harmless or tesjl 
dangerous than the carbonate Jend themselves to the varied 
practical requirements of the manufacturer. 

** 3- W^hat other preventive measures can be adopted." 

Singly or tc^ether, Professor Thorpe and I not only visited 
the potteries in StafTordshire and Scotland, but also several 
of the leading manufactories on the Continent, e^., Delft, La 
LouMire, Maestricht, Copenhagen. Charlottenbui^ Dresden, 
Limoges, Choisy-le-Rot. and Montereau, &c. Our opinions 
and recommendations to the Home Secretary are embodied^ 
in a Blue Book which was [iresented to the House 
Commons in February, 1899. These recommendations wer 
as follows : — 

" 1. That by far the greater amount of earthenware of thfl 
class already spcciiied, i>., w^i'tg and cream-cohured war^ 
can be glazed without the use of lead in any form. It has' 
been demonstrated without the slightest doubt that the ware 
so made is in no respect inferior to that coated with lead 
glaze. There seems no reason, therefore, why in the raanu- 
facturc of this class of goods the operatives should still 
continue to be exposed to the evils which the use of lead 
entails. 

"2. There are, however, certain branches of the pottery 
industry in which it would he more difRcult to dispense with 
the use of lead compounds. But there is no reason why, in 
these cases, the lead so employed should not be in the form 
of a fritted double silicate. Such a compound, if properly 
made, is but slightly attacked by even strong hydrochloric, 
acetic, or lactic acid. There can be little doubt that if lead 
must be used, the employment of such a compound silicate — 
if its u.*e could be insured — would greatly diminish the evil 
lead poisoning. 

" 3. The use of raw lead as an ingredient of glazing material, 
or as an ingredient of colours which have to be subsequently. 
6red, should be absolutely prohibited. 

"4. Ab ft would be very difficult to insure that an innocuous' 



METALLIC POISONS, DUST, FUMES. ETC. i6i 



■'J 

■el' 



lead glaze shall be employed, we are of opinion that young 
peraons and women .should be excluded from employment as 
dippers, dippers' assistants, ware cleaners after dippers, and 
glost placers in factories where lead glaze is used, and that 
the adult male dippers, dippers' assistants, ware cleaners, and 
gloist placers should be subjected to systematic medical 
inspection." 

It was impossible that these recommendations should be 
received with general approval. We were dealing with an 
otd-cstablished industry. Trade customs die hard and new 
methods of manufacture arc costly. However wishful pottery 
manufacturers might be to adopt our recommendations, there 
were financial and economic considerations that could not be 
ignored. As no unanimity could be arrived at between 
employers and the Home OBicc as to the means by which 
plumbism in the potteries could be diminished, a compromise 
was effected, but the matter had ultimately to be referred to 
arbitratioa The Court sat at Stokc-on-Trent in November, 
1901, and was presided over by Lord James of Hereford. 
Previous to this, however, there had been much that led up 
arbitration, as the sequel shows. The use of leadless 
glazes for certain goods, the more frequent use of fritted lead 
in the form of a double silicate, abolition of raw lead in the 
glaae, and the exclusion of young persons and women from the 
dipping and ware-cleaning departments and as glost placers, 
were the principal recommendations made by Professor 
Thorpe and myself. There was not the least doubt that at 
the time the inquirj' was undertaken raw lead had been used 
by the Sta06rdshire pottery manufacturers with far too free 
■ hand, and it was clear that this could not go on, judging 
from the amount of lead poisoning in the trade. As to what 
the quantity of lead in the glaze should be, the master 
potters themselves were divided. Some manufacturers stated 
that 30 per cent of lead was required, while others thought 
that 10 per cent, was sufficient. I'rofessor Thorpe found 
excellent examples of lead-glazed ware in which the lead 
monoxide did not exceed 12 per cent of the total weight of 
the glazing materials, while in the liquid obtained from the 
ipping tubs ((>., the glaze solution) of some of the manufac' 
v 




1 62 



DISEASES OF OCCUPATION 



turers he found the lead varied from 13 to 24 per cent, and] 
even higher. As a result of the trend of events at this da< 
and of Professor Thorpe's experimtnts and recomtnendatio 
a conference of representatives of manufacturers and of the 
Home Office was held at the Home Office on October 31, 
1899. Two months afterwards the Home Secretary {Sir 
Matthew White Ridley) intimated that he intended after a 
certain interval to propose that there should be in potteries a 
standard of Insolubility of fritted lead for glaus, the standard 
of insolubility being that the Rla^e should not yield more 
than 2 per cent, of lead when acted upon by hydrochloric 
acid under certain conditions. The manufacturers considered 
the 2 per cent, of insolubility too hard a requirement, and 
suggested 5 per cent instead. The main object of the 
inquiry undertaken by us was to surest means whereby 
lead poisoning in potteries might be dimini'^hed without^ 
doing any serious injury to a trade which, both at home andn 
in foreign markets, was severely hampered by unlimited 
competition. The attenti«n of manufacturers wa.s drawn to 
the fact that if the stand:ird was 6xed at 5 per cent, this 
would allow of the use of a glaze from which it was possible I 
in one hour to extract one-third nf the lead by dilute acid at 
ordinary temperatures, and that this would only perpetuate 
the evils that were then existing. Meanwhile employers, 
working under Special Rules issued four years previously by 
the Home Office, were doing something to improve the 
methods of manufacture, so that when the Arbitration Court 
met at Stoke-on-Trent statistics were put forward whic 
showed that a notable declension in the number of cases 
lead poisoning in the potteries had occurred — a fall from 
to 3"S per cent. This circumstance, which of itself 
ample proof that the inquiry had been necessary, also showed 
what could be done by the manufacturers themselves when 
stirred to action, and was earnest of what might yet be 
accomplished. Tiiis apparently was the view taken by Lord 
James, for after a five days' sitting of the Court he postponed 
arbitration for eighteen months, so that manufacturers might 
have the opportunity of giving the Special Rules a longer 
trial, that additional experiments with fritted lead might be 



;ourt 

hiclod 




METALLIC POISONS, DUST, FUMES, ETC. 163 






made, am) that a scheme or mutual assurance might be 
established between employers and workpeople. 

The adjourned arbitration took place at Stokc-upon- 
Trent on June 30 and July t, 1903, Lord James of 
Hereford, as heretofore, acting as umpire The object of 
the meeting was to coruider and discuss statistics relating 
to cases of lead poisoning which had occurred in potteries 
since the meeting held in November. 1901, and to settle 
upon some definite course in regard to certain points in the 
rales which had been so hotly disputed eighteen months 
previously, viz. : (a) the use of fritted lead in the dangerous 
and dusty processes, {d) no glaze to be used which yie]c3s to a 
dilute solution of hydrochloric acid more than 2 per cent, of 
its dry weight of lead calculated as lead monoxide, and (c) 
monthly medical examinations of the workers, with power of 
suspension by the certifying surgeon, [n closing the inquiry 
Lord James announced that he would give his decision in 
writing within three weeks. The text of his award became 
the bisis of a series of Amended Rules which were issued by 
the Home Office, and in which the spirit of compromise is appa- 
rent. Since the fritting of lead if performed in a slovenly 
manner is only a false protection, this was not made compul- 
sory. No glaze was to be used which yielded to 025 per 
cent solution of hydrochloric acid more than 5 per cent, of 
its dry weight of lead calculated as lead monoxide, there was 
to be a monthly medical examination of workers employed 
in certain specified processes, witli power of suspension by 
the certifying surgeon, casual workers were to be examined 
at their own expense, a hea.lth r<^istcr was to be kept, over- 
alls and bead coverings were to be provided and maintained 
by employers for women and young persons employed in 
certain specified processes, respirators were to be worn by 
persons in the mixing of unfritted lead compounds and in the 
preparation of fritts and glazes, drying stoves wcr« to be ven- 
tilated, the floors of the workrooms were to be sprinkled and 

ept daily, and a scheme of compensation for lead poisoning 
arranged. Under these Amended Rule* the trade h.is been 
practically working since. It would be an advantage if a 
special room were set aside In the factory for the monthly 



I64 



DISEASES OF OCCUPATION 



medical cxamiriation of the worlcpeople. Funds and existing 
arrangements do not admit of the certifying sui^eon being a 
purely Govcmnicnt ofHcial. but it would be a gain generally 
were he such. He would be more independent of cmpIo>-crs 
than the local sui^oons whoat present discharge thi-i function. 
The subjoined table supplies information as to the nuniber 
of cases of lead poisoning in the Staffordshire potteries before 
arbitration and since : — 



Prom the Varth Staf- 
fordshire PolUnrin 
[KMrict 

KroiD olhcr DUiriciiin 
thcHnilHl Kingdom 



igcfc 



•ga&. 



ivt- 



igq. 



ign 



l«M- 



iqm 



rt»g. 



Taking the total number of cases of lead poisoning 
occurring in several of the important departments of china 
and earthenware manufacture and reported to the Home 
OfHcc, the follotving statistics, extracted from the Annual 
Report of the Chief Inspector of Factories for 1906, are of] 
value:— 

TOTAL CASES REPORTED AS OCCURRING IN— 





i9>t. 


1905 


ao 
8 

30 
36 


IflOJ. 


It 

« 

3 
la 

■i 
19 


I9«. 
19 

4 
4 

II 
1 

'3 


1^0* 


'•n- 


u 

Oippm' MSistant* ■■. p ' 
Ware deanen ... 1 p_' 


33 

5 
4 

■9 
t 

iS 


13 

4 
4 

>5 
3 

14 


1 
6 

18 
5 

15 


36 
44 

73 


13 
at 

i 
33 


Total iu d)p[Kn£ botM | p_ 


18 
4i 


19 
33 




>5 

34 


16 
35 


It 


54 
71 


M^ijoUca painter* ... j p_ 


7 


1 

7 


7 


le 


3 


r 
S 


S 


»S 



METALLIC POISONS, DUST, FUMES, ETC. 165 



PROPORTION OF CASES TO PERSONS KMPLOYKD 





>9>& i-ns. 


•«<>*■ 


IW3- 


■OM 


ign. 


•9M 


•>A 


lit 

Wppcnt j p." 

Dippers' UM»tanN... j j. ' 
Ware cicanen ... jp 


0-9 

49 
ro 
4t 


Per 

CmL 

'■5 

3-0 
3-i 


Ctnt. 
2-6 
(yt 

$•9 


Pe. 

Cnu. 

crS 
l-J 

47 

r4 


Ohil 
'■5 

33 
l-o 

4' 


P«r 
Coil. 

30 
i-o 
5^ 


Cent. 

4-a 

4'» 

fro 
V5 


I'M 

Omt. 

30 
72 


3Mal in dipping IM. 

tuam \F. 


at 

13 


•■4 
34 


'5 

5-0 


35 


3« 


1-8 
4'f 


'1 
78 


4-0 
7* 


Mafolica paintcre ... p' 


3-3 

13 


'■3 


Tb 


^ 


1010 

1-0 


I* 


SO 



The numbers of persons employed in the dipping-house 
were, in 1900, [,336 males and 929 females; and in 1904, 
1,336 males and 963 females. The percentages for the years 
[906 and 190; are calculated on the return of persons em- 
ployed in 1904. The total numbers of persons employed in 
processes in which lead is used were, in 1906, 4,224 males and 
2,148 fciTialcs, or a total of 6,3/3 ; in 1904, 4,394 males and 
2.300 females, or a total of 6.694 males and females. The 
number of fatal cases, in which lead poisoning contracted in 
earthenware and china works is stated to have been directly 
or indirectly the cause of death, was 16 out of a total of 31 
from all industries in [899, 8 out of 38 in 1900, s <^ut of 34 
in l90ii 4 out of 14 in 190Z, 3 out of 19 in 1903, 4 out of 
36 in 1904. and 3 out of 23 in 1905. 

Taking china and earthenware alone, there were reported 
to the Hume Ofiice the following number of cases during the 
last eight years : — 



t906< 


1905. 


19M- 


1903. 


19C». 


igoi. 


I90CK 1899. 


107 


84 


106 


97 


«7 


106 


300 


349 



166 



DISEASES OF OCCUPATION 



While the preceding tables show an tmprovement in the . 
health of persons employed in the manufacture of china and ^| 
earthenware in 1906, compared with 1899, the number of ^^ 
cases of lead poisoning in the potteries is not only higher 
than it ought to be, but there has not been the declension in 
recent years that had been hoped for. By loyally carrying 
out the Special Rules employers and employed have certainly 
succeeded in reducing the amount of industrial lead poisoning, 
but what would ^'vc the greatest satisfaction to the public 
would be knowledge of the fact that the manufacturers them- 
iKlves were taking greater scientific interest in their work, 
combined with an increased regard for the health of their 
workpeople, so that by the introduction of new methods their 
own regulations would always be in advance of those put for- 
ward by the Home Office, Instead of Tollowing, manufacturers 
should lead. This brings us to the much-debated question 
as to whether it is not possible to manufacture china and 
earthenware without the use of lead glascs. 

Ltadiess Glast 
The use of leadtess glazes has been consistently opposed 
by a targe number of the manufacturers on the ground that 
without the presence of lead in the glaze they ca.nnot get tlw 
depth and beauty of colouring which arc so much admired. 
In the Thorpe-Oliver report it is shown that by far the 
largest proportion of earthenware can be made without 
lead in the glaze, and that even where special colours arc 
required and the demand for lead insisted upon, a smaller 
percentage of lead than that hitherto in use ts sufficient. 
An exhibition of leadless glaicd pottery wa* recently held 
in Westminster House. Those who had the opportunity 
of inspecting the various product* could not be but Im- 
pressed by the high-class character of the goods exhibited, 
and by the variety, depth, and beauty of the colouring 
dlspUyed. It is true that leadless glared ware Is more 
apt to go wrong in the Bring, and that at present it is 
more expensive to produce, but these are trade and economic 
problems which manufacturers would readily overcome if 
there was the stimulus of M increasing demand for the goods. 




» 



METALLtC POISONS, DUST, FUMES, ETC. 167 

Manufacturers will only make what they can sell. Since all 
sanitary and office goods can be produced just as well with- 
out lead 33 with it, public bodies should set the example in 
their contracts of asking for Icadless glazed ware, and if this 
were done an increasing public demand for domestic ware 
similarly prepared would end in creating, through the spirit 
of competition aroused, a supply that would prove just as 
satisfactory as lead glazed ware. The greater use of leadlcss 
glaze? would obviate much human suffering. If manufac- 
turers have hitherto been <>tow in moving in this matter on 
the lines indicated above, now that industrial lead poisoning 
has been scheduled for compensation under the Workmen's 
Compensation Act this circumstance may force them to 
reconsider the subject and to approach it from fresh 
standpoints. 

The principal objections to leadlcss glazed ware advanced 
by manufacturers are the increased cost of production 
and the unreliability of the ware in passing through the 
ovens. The goods are said'to "craze" more readily, i>., 
for the glaze to become cracked, and this means a mone- 
taiy loss which they cannot afford. The exhibition of 
leadlcss glazed pottery at Westminster House already 
referred to was at the time much decried by several of 
the manufacturers. It was said that it was unfair to 
expect them to produce at a greater cost leadlcss glazed 
ware, which ware, if glazed with lead, could be manufactured 
at a cheaper rate abroad, and introduced into and sold in this 
country at a lower figure than it could be made for at home 
To say nothing of competition in foreign markets, it would 
spell ruin, so it was said, to the home trade, especially as in 
other countries there were no restrictions as regards the use 
of lead in (Mtteries. I question very much whether in France 
or Germany there has been anything like the amount of 
lead poisoning in potteries that there has been in Stafford- 
shire. The subject of plumbism in potteries ha.s, at any rate 
on the Continent, never become the acute and burning ques- 
tion it has been in this country owing partly to different 
metlvKis of production. In England it is not that manu- 
facturers cannot produce leadtess glazed ware, for W. I. 





i6S DISEASES OF OCCUPATION 

Fumiral,^ research ceraniist and consulting potter, says thai, 
even from the manufacturers' evidence, the production of 
Icadtes!) glazed ware in " wlwle ovat/uls exclush-tly \% in 
certain cases practicable." It Is the absence of a demand 
for it on the part of the |)ublic, who are deterred from pur- 
chasing the ware by its higher price, that is to a large extent 
the reason why it is not manufactured. That leadlcss glazed 
ware has great durability is shown by antiquarian discoveries 
Egyptian potters used a glaze composed of silicate of soda 
without lead, probably because the soil of Egypt, being rich 
in alkali, did not require the addition of lead. Brongniart in 
speaking of the enamelled bricks found in the ruins of 
Babylon, which go back to not lets than 522 B.C., tells us 
that chippings and scales of these ancient bricks, when 
examined in the laboratory at Sivrcs by MM. Salvdat 
and Lenormant, were found to contain neither lead nor 
tin. In Assyrian and Persian pottery lead was frequently 
used, but for durability and colour they arc not superior to 
other pottery in which no lead ifras employed in the glaze. 

in addition to risks to health from lead poisoning, there 
are certain departments of china and earthenware manufac- 
ture that arc dangerous from the dust that is created. The 
bronchia) and puimonar)' troubles thus caused are dealt with 
in the chapter devoted to lung diseases caused by dust. Here 
it is only necessary to say that, taking the death-rate froni 
pulmonary consumption as 100 for agricultural labourers, that 
of potters for the same disease is 453 ; in other words, Ibr 
every 2 agricultural labourer* dying from consumption there 
perish 9 potters. 

FiU Cutting 
File cutting by hand is an unhealthy occupation. The 
death-rate of lilc-cutter« from (Hilmonary phthisis and lead 
poisoning exceeds tlv; mortality standard of ordinary occu- 
pied males by 90 per cent, and after 35 years of age it 
ia still higher. The explanation of the unhealthy nature of 
the trade is not far to seek. The work is frequently carried 
on iSi *matl buildings m the rear of dwelling-bouses and in 
• ••LewUou Decorative TiJo, FaicDC«, and Houuc," 1904, p. 19. 



« 



jH 




I 



METALLIC POISONS, DUST, FUMES, ETC. 169 

yards in which there ts little circulation of air. In most of 
the workshops there is no ventilation. The floor b fre- 
quently tJie ordinary soil. Men and women work together, 
and overcrowding is common. In file cutting by hand the 
man or woman sits astride a "stock." in front of him is a 
stone block, into the centre of which a piece of steel bar called 
a "stiddy" is inserted, and on this "sliddy" is placed a piece 
of metallic lead which is called the " bed." When about to 
be cut, the file is strapped fUt on the " bed." By means of 
a hammer arvd chisel Unc lines are made upon the iilc, each 
line representing a blow from the hammer. As the hammer 
usually weighs from / to 9^ lbs., and on large files there may 
be as many us 3.S00 lines, a considerable amount of muscular 
eflbrt is exerted by the file-cutter in the course of the day. 
When one face of the file has been cut it is lifled from the 
bed, nibbed vith charcoal or chalk, and then replaced, cut- 
facc downwards, for the other side to be cut. There is a 
considerable quantity of dust given off when the file is 
rubbed with charcoal, also during the cutting of the file. In 
an examination of the dust collected from the rafters of a 
file-cutting shop there were found 2*64 grains of metallic 
lead: in dust taken from the top of a "stock " 14-82 and 
Z2'28 grains per 100, and from the floor under the " stock " 
^63 and 4-37 grains per too. The work h extremely dusty. 
File-cutters are notoriously wanting in personal cleanliness. 
To the practice of taking their food into the workshops, 
and of eating it there without washing, to the disagreeable 
habit of licking their lingers when at work so as to get a 
better grip of the chisel, also to bending down towards the 
" stiddy " when at work and thus inhaling the dust, must be 
attributed much of their ilt-hc-alth. .<\llhough, in the dust 
given oflf, the lead is mostly in the metallic state, still there 
is always a certain amount of oxidation going on which 
renders the lead capable of absorpUoa 

The men and women who fallow this occupation soon 
become anx-mJc, and many of them suffer from colic Para- 
lysis of the extensor muscles of the fingers and wrists is 
frequently met with in file-cutters. This affects mostly the 
left hand, since it is by the muscles of this hand that the chisel 




170 



DISEASES OK OCCUPATION 



is Rraspcci, and muscular strain and fatigue prcdi<iposc to pa 
lysis caused by lead. The hand that wields the hummer does 
not always escape, so that in many instances the paralysis is 
bilateral. Frequently in file-cutters lead poisoning assumes 
tbe chronic form, so ttiat in persons following this trade the 
death-rate from Icidney di<tease is unusually high. The 
number of cases of lead poisoning in file-cutters reported to 
the Home Office during the last few years has been as 
follows >— 





1906. 


1905. 


1904. 


1903- 


1901. 


1901- 


1900L 


l>99- 


File 
cutting 


'5 


13 


30 


=4 


27 


46 


40 


4» 



In Sheffield alone, which is the principal seat of the file 
cutting industry, the number of cases of lead poisoning has 
been falling. In 1903 there were 18 cases; in 1904, 17; Jq 1 
1905, 10; and in 1906, p. 

Since lead poisoning contributes so largely to the ill-health 
of file-cutters, various substitutes for the bed of metallic lead 
have been tried, but without success. File-making by 
machinery is replacing file-making by hand, and is becoming 
an important trade in Sheffield. In order to harden files it is 
customary to dip them into a bath of molten lead. The men 
who dip the files occasionally suffer from plumbism, due to 
the fumes of the molten metal, but this can be prevented by 
vcniilation and hooding of the bath. 



Diatnond Cutting: Setting of PrecicHS Status 

Diamond cutting is one of the old industries of Amster- 
dam. The market for diamonds is London, but the workshop 
is Amsterdam. A branch of the trade has sprung up in 
Antwerp. The men who follow the occupation are well 
paid : they are Intelligent and well-educated. Many of them 
can make from £4 to j£,5 a week. The work 
oonsidciabic skill, and by demanding close attention 



requires ^j 
cntion It ^M 



METALLIC POISONS, DUST, FUMES, ETC. 171 



[tDposes a gcxx) deal of strain upon the eyes. The numbu' 
of men employed in Amsterdam in diamond cutting is S,ooa 
Many of the men sufTer from lead jxtisoning. In my visit 
to one of the largest diamond cutting shops in Amsterdam, 
^ving employment to 4CX> men, I was struck by the high 
temperature of the workrooms and the want of fresh atr. 
The large number of gas jets in use explains the over- 
heated condition of the workrooms, while to the sedentary 
nature of the work and enfeebled resistance to cold, as in 
nearly all indoor occupations, must be attributed the defec- 
tive ventilation and dread of open windows. 

In order to cut a diamond another diamond i3 required ; 
hence the saying " diamond cut diamond." After this 
preliminary cutting the diamond is fixed in a mass of molten 
metal, about the size of a walnut, containing 60 per cent. 
of lead and 40 of tin, and the alloy is allowed to cooL 
Thus securely fixed in the metallic knob, the diamond is 
subsequently polished by hand or by an iron wheel rotating 
at the rate of 2400 m-olutions per minute. It is during 
the fixing of the diamond in the lead alloy and afterwards 
during the polishing processes that the workmen run the 
risk of becoming poisoned by lead. The skin of the fingers 
of the workmen is quite black through coming into contact 
with the hot metal and the varnishes used, but there is 
aUo a good deal of lead dust, probably in tlic fonn of 
lead oxide, floating in the atmosphere of the workroom, 
inhalation of which is one of the causes of plumbism. 
Nearly all of the men were extremely pate, and several 
of them showed the characteristic blue line on their gums. 
Some of the men had suffered from lead colic and a few 
of them from loss of power in the muscles of the hands 
and wrists. The subject of lead poisoning in diamond- 
cutters was recently taken up by the Dutch Government, 
and a prize of ,£500 was offered to any person who would 
find a reliable substitute for lead to hold tlie diamond 
during the polishing of the stone. Ho prize has as 
yet been awarded, but the Government is on the eve of 
making an important announcement in regard to this 
subject. 





172 



DISEASES OF OCCUPATION 



Sttfing and Polishing of Precious Stoms 

What has been said of diamond cutting applies with] 
equal force to the cutting and polishing of other precious' 
stones. The Medical Officer of Health of Rcichcnbci^, 
Bohemia,* has drawn attention to the targ^ number of cases 
of lead poisuning in the men employed in polishing precious 
stones in the workshops of Turnau and neighbourhood. 
There were 25 men sufTerJng from lead ooHc and paralysis. 
These, however, were as nothing compared v%-ith those who 
made the cutting and polishing of gems a home industry,^ 
As a consequence of making their living-rooms thdr work- 
shop and of sitting down to their meals without washing' 
their hands and face, the men were pale, and nearly all 
of them exhibited a well-marked blue line on their gums 
Their work consists in polishing garnets, and for polish-l 
ing 60 dozen stones the men receive 50 kreutzer (4s. Sd.).' 
The polishing is done on pieces of metallic lead which have 
from time to time to be remclted in tlie pot. The men are 
thus exposed boUi to the fumes of molten lead and to dusL_ 
It is stated that tnctallic lead is not absolutely necessaryj" 
and that in the technical school the 6xing of the stonesi 
is done by means of copper and zinc. Notwithstanding^ 
this fjact the workmen at their homes stUl adhere to 
use of lead, and as a result there arc many cases of lead! 
colic and pamlysis among gamet-poltshers. 

Plumbism is also met with in polishers of other kinds 
of gems and precious stones. 



EnameUing of Iron Plaits and Holloxa Wttrt 

The enamelling of iron plates and hollow ware is one of 
the industries of ihc "Black Country." It is carried on in 
^Birmingham, Wolverhampton, and the immediate iwighbour- 
hood. Nearly all the large enamelled plates at railwa 
stations announcing the name of the station, atso' the 
enamelled advertisements, are made in the districts just men- 
tioned. The process of manufacture can be told in a few 

* "Les Industries Inulubres," p. 91. 



■-A 




METALLIC POISONS, DUST, FUMES. ETC. 173 

ords. The iron plates are first cleaned, then smeared 
with a thin solution of g^um and subsequently are powdertd 
with metallic <lu8t, or a liquid containing a metallic powder 
is allowed to trickle over them. The powder used often 
contains as much as 25 per cent, of a fritted lead com- 
pound ; in other instances there may be no lead at all. 
Having: received its first coating, the plate is placed in an 
oven and exposed to a high temperature. On its removal 
and after having become cooled it is swilled with water. 
The colours required are put on with brushes, and when 
this has been done the plate is laid upon hot pipes, moder- 
ately heated, to dry. Up to this stage all the work has 
been more or less wet and has not been dangerous to 
any great extent ; besides, the lead compounds used have 
been fritted and arc therefore lc»s soluble. The alphabetical 
letter*, words, and numbers, &c, that are lo appear on 
the plate when finished are obtained by placing a stencil 
with all the letters cut out of it upon the plate, and by 
women and girls with brushes rubbing off the surface of 

, the plate exposed through the cut letters of the stencil. 

[During this pnxress lai^e quantities of dust are given off, 
and if down-drau.i:;hts have not been provided the atmosphere 
of the workroom becomes so thick that it is impossible to 
see acrossthe room, while the hair and clothing of the workers 
become covered with coloured dust. This dust contains 
varying quantities of lead, which is inhaled, and conse- 
quently induces lead poisoning in those exposed to it. 1 
have known it cause death in young females by acute lead 
encephalopathy. 

The stencilling of the plate is generally carried on over 

'perforated tables with a strong down-draught, so that the 
dust is carried downwards and away from the workers, 
it unless care is taken to see that the aspiration is 
powerful enough the dust rises upwards towards the face 
of the worker. 

AEler the plate has been stencilled it is again placed in 

'the oven, and if additional letters or words have to appear 
upon the plate differently coloured from those first inscribed, 

ta simitar process to that just mentioned has again to be 



^74 



DISEASES OF OCCUPATION 



gone through, viz., dusting, or sprinkling, drying, stencilling, 
rubbing-otr, and iiring. Red lead and other com{X>unds of 
lead are largdy used in enamelling, and these are, as already 
stated, often present in the powder or solution to the extent 
of 25 to 35 per cent. Formerly arsenic was used in the , 
enamelling of iron plates, but as it was the cause of !aerious^| 
ill-health among the operatives it had to be abandoned. ^ 

No female under twenty ye*rs of age should be allowed 
to follow this oecupation. Only healthy women should be 
employed, and then only after a medical examination. 
Periodical medical inspection of the workpeople, with im- , 
proved methods of ventilation, has done much to reduce tha^| 
number of cases of lead poisoning in the enamelling trade. ^ 

in the tinning and enamelling of hollow ware, which 
is an industry also confined to the "Black Country," the 
pot or saucepan to be tinned is first swilled with a mixture 
of dilute hydrochloric acid and zinc chloride. After it has 
thus been cleaned or prepared it is dipped in a bath of 
molten tin and lead, usually a mixture of 40 per cent of 
metallic lead and 60 per ccnL of tin, but as tin is the more 
expensive of the two metals the molten liquid 6?equently 
contains as much as 70 per cent, of lead and only 30 per 
cent of tin. Ware dipped in this bath is sold at a lower 
price. Unless the metal-pot is hooded so as to rcmo 
the fumes, the man who dips the ware in the bath, if he 
is not cleanly and careful, may suffer from lead poisoning. 
On an average there are 18 cases of plumbism reported 
the Home OfHce as occurring in this trade every year. 
Dippers who are intemperate are specially predisposed to 
lead poisoning. The risk of lead poisoning is not con- 
fined to the dipper of the hollow ware, but extends to the 
users of the pots and saucepans, and since it is the poorer 
working classes who purchase the cheaper ware, nominally 
tinrntt but really Uaded, they suflTer in health owing to 
eating food thut has been cooked in the utensils, the lead 
in the tinned lining inside the vessel having been dissolved 
out in the act of cooking. In what is known as the white 
enamelling of iron hollow ware many manufacturers are 
now making um of leadless glaze. Occasionally the men 




METALLIC POISONS, DUST, FUMES, ETC. 175 




who manufacture the? white enamelled alphabetical letters 
used for advertising purposes, and which arc seen on shop 
t windows and elsewhere, suflTer from plumbism. During the 
acts of "bmshing on" and "wooHn'g off" lar;;e quantities 
of dust are evolved from the coloured powders used, and 
as these often contain lar^c i^uantities of lead there is 
danger from inhalation of the dusL 



EUi^triaU Atcumuiahr Works 

Owing to the increasing demand for electricity for lighting 
and motor purposes, also for telegraphic and telephonic 
requirements, the manufacture of electric accumulators has 
become an important industry both at home and abroad. 
Although the employment of electricity in this country has 
much increased of late, it is small in proportion to what it is 
in Germany. In the manufacture of electric accumulators a 
paste made of red lead and sulphuric acid is rubbed into the 
openings of perforated metallic plates. Usually the work- 
man wears indiarubber gloves, but these get thinned, torn, 
and worn out In time. In the act of mixing the red lead and 
sulphuric acid so as to make the re<{utrcd paste the workman 
becomes enveloped in dust. There is no reason why the 
litharge should not be lifted by some mechanical means and 
not by a scoop, nor why the mixing should not be done 
in a hermetically closed chamber with extracting draught. 
A few years ago the number of cases of lead poisoning jn 
electrical accumulator works in Germany had risen so high 
that the Imperial Healtli Office directed an inquiry to be 
made into the conditions of labour ia the works. New 
regulations were introduced, and since then plumbism has 
become Ics« frequent. In Great Britain, notwichManding the 
vigilance of the Home Office, the number of cases of lead 
poisoning in accumulator works continues to be higher than 
k ought to be, as the table on jx 176 shows. 

Mr. Kellet, H.M. Inspector of Factories, states that nearly 
all the cases of lead poisoning in his district occurred in one 
electric accumulator works. It would appear that there is 
a tendency in this country to start accumulator works in 




DISEASES OF OCCUPATION 



I 



NOTinCATION OF LEAD rOISOITIKG IN 
ACCUMULATOR WORKS 


ELECTRICAL 


19C1& 1905. 


1904. 


1903- 




1901. 


19001 


l«9» 


36 37 


33 


18 


t6 


49 


a 


32 



Mixers, pasters, and labourcn 


... 


... 45 CM« 


l^ead burnefs 


... 


... 16 „ 


Ca&ttn 


... 


• 5 " 


Luid sawyen 


... 


» ,. 


Stoker 


... 


... I „ 



premises that are quite iinsuitabte for die purpose. The 
result is always unsatisfactory and diingcrous from a health 

■ point of view. Before such work is begun the premises 
ought to be inspected by representatives of the Home Office, 
and not, a» is too often the case, when damage to health has 
been done. In a large electric accumulator works in which 
the cases of lead poisoning had fallen from 24 in 1901 to i 
in 1905, Dr. Hugh Hughes, of Ashton, gi%-e$ the following 

H report of the 69 cases which had occurred in the factory 
during the 9 years from 1897-1905 : — 

I In the Report of the Chief Inspector of Factories for 190^ 
B the occupations of the 36 persons attacked with plumbism 

■ electric accumulator works are as follows :— 

^^^^9 no mention is made in the last table of the numbers 
employed in electric accumulator works in this country, I 
give the following as the experience of one of the large 
accumulator works in Germany In order to show what are 
dangerous procesid :— 



Pwters 






... 


7 cases 


Lead burners 






... 


5 » 


C*»ters 






... 


» 1. 


Packers and makers-up 






■". 


9 .. 


Minr 






... 


' »» 




m 



METALLIC POISONS, DUST, FUMES, ETC. 177 





fivBDvn 


NnmbpT nt Cun of 




Ocaiparion. 


«inpJ«ytd. 


I.aiJ Puii»iii»|;. 


Pot^nuge. 


mm 


30 


3 


lO'O 


■il 


30 


9 


30-0 


Soldering 


16 


6 


375 


Trimming 


30 


4 


13-3 


Plumbing 


30 


9 


JO'O 


Section building ... 


60 


S 


8-3 



Clearly the soldering, p&sting, and plumbing arc dangerous 
spartments. Much of the plumbism i^ ppeventible. The 
*nien on commencing work for the first time slrould have 
the dangers and the risks of the employment clearly pointed 
out to them, also the advantages of personal cleanliness and 
the use of warm baths. If warm baths arc to be taken — 
and my remarks apply to all factories in which lead is used 
— the opportunities of doing so must be provided at the 
works by the employers, who should supply plenty of soap 
and towels, and the time required for wa^itng should count 
as time spent at work in the factory. The baths provided at 
a large number of British factories are a disgrace and not fit 
for men to go into. It is all very well to say that workmen 
engaged in lead processes should take baths, but I have seen 
bath places in British factories and paint shops into which no 
man with any self-respect could go, and untilcmployers grasp 
this fact and provide proper accommodation, suitably heated, 
alwi towels and soap, they cannot exj^ect workmen to loyally 
carry out the recommen<lation in regard to balhs. At several 
of the lar^c works in Germany which I have visited the bath- 
rooms form aseparate j)artof the factory, arc properly warmed, 
and are under the direction of a special attendant Discipline^ 
which t% such a feature of all German life, may have some- 
thing to do with the fact that there is no difficulty in getting 
the workmen to take the baths, but the excellent character 
of the baths is not without an attractive inducnoc. In some 
works a patent soap, known as akrttMttiM, \» used. It is said 
contain a sulphur compound which precipitates the lead 




i7» 



DISEASES OP OCCUPATION 



The 



on the skin as lead sulphide, 
stoker referred to in one of the previous tables is not with- 
out interest He had been in the habit of breakirif; up the old 
red lead barrels and of burning the wood on the boiler 
fire. I have known of cases, too, In bakers who heated 
their o\fenB in this manner, also in workmen who were 
engaged in breaking up old railway carriages and burning 
tlie wood. 



PriHling: Type-foHtiiiing, Typr-sttttHg, Limtyfing 

Linotyping is rapidly displacing printing by type set by 
hand. Printing by the old method is not a healthy occupa- 
tion. The rooms are kept too hot and are badly ventilated. 
There is a higher tlcath-rate from pulmonary phthisis among 
printers than in most indoor occupations, and plumbism 
is not unknovm o»-ing to the men handling the type and 
inhaling the dust that is given off. Type metal is an alloy 
of lead with J to J of antimony. The antimony is added to 
give hardness to the type. Occasionally tin and copper are 
added in small quantities. 

Several years ago the opinion was expressed by two 
French physicians, Tanquerel and Fidoux, that there exists 
an antagonism between lead poisoning and tubcreulosts, 
U., that the one tends mutually to exclude the other. 
Experience does not confirm this statement The high 
death-rate of lilc-cuttcrs from tuberculous phthisis, who, 
as a class, suffer much from lead poisoning, is proof to the 
contrary. From recent annual reports of tlic Typographical 
Association and of the London Society of Compositors it 
would appear that there has been a slight increase in 
tuberculous disease over the corresponding rate for the 
whole country, .so that it must be admitted that printers arc 
more liable to tuberculous phthisis than men engaged in most 
other indoor trades. Lead poisoning, therefore, instead of 
excluding tuberculosis, predisposes to it A few years ago 
Hirt showed that pulraonarj- phthisis is much more fre- 
quently met with among persons working in an atmosphere 
containing lead dust than in thoite exposed to the 



I 



influence ^1 



METALLIC POISONS, DUST, FUMES, ETC. 179 



of iron and copper. While workers in iron and copper 
supplied 1 2 per cent, of phthisical patients, lead workers 
contributed 2( per cent. Twenty years ago a French 
physician, Lciidct. pointed out the rapid development uf 
pulntonary phthisis in persons sufTertng from chronic lead 
poisoning. That plumbism reduces the vital resistance there 
is no doubt. Probably this is the only r6lc that it plays 
In the development of tuberculosis, for in all the lead 
industries in which phthisis is met with in excess, other 
agents are co-operating, such as dust or bad air accom- 
panied by high temperature and imperfect ventilation. It 
is certainty the case that pulmonary tuberculosis in oftener 
met with in lead than in coal and iron miners, but this is 
not due to the fact that the men arc mining lead ore : it 
is the consequence of working under unfavourable condi- 
tions as regards ventilation, and of domestic and social 
conditions more or less accidental to lead mining. White 
lead workers do not die from tuberculosis in larger numbers 
than persons engaged in other trades, but file-cutters and 
printers show a high death-rate from this malady — the former 
as the result of dust and lead, the latter as the result of bad 
air and dust. 

The number of cases of lead poisoning notified in printen in 
Great Britain during igo6 was 16, and for the previous seven 
years 19, IS, 13. 19, 33, 18, and 26 respectively. In the iG 
cases for 1906 are included, according to Dr. T. M. Lcggc, 8 
compositors. 3 stcrcotypers, 2 machine operators, and i type- 
caster. While of the 19 cases reported in the previous year 
there where 10 compositors, 3 of whom died, 1 was a stcrco- 
typcT, I a linotype machinist, i a type assorter, and i a type- 
caster. It is the comfrasitors who suffer mosL Although the 
numberof cascsof lead poi.>ioning among printers is not lai^c, 
yet the symptoms are often severe. Paralysis is frequent, and 
the cerebral type of lead poisoning, which is the worst of all, 
is not unknown. To the fumes given off from the casttng-pot 
or lino melting-pot must be attributed some of the cases of 
plumlMsra in printers, but it is impossible to exclude the 
dust caused by the abrasion of the metal in the compositor's 
box, also the possibility of absorption through the skin by 



xSo 



DISEASES OF OCCUPATION 



handling the type. The tlust in printing-shops creat 
daring the wear and tear of type has been found to con- 
tain as much as 14 per cent, of lead, and it is impossible to 
avutd inhaling some of this dust. In Newcastlc-upon-Tjmc 
there has been during the last few years a marked declension 
in the number of ca-ws of plumbism in printers. There is 
nutlitii^ like the amount of lead colic and paralysis that 
prevailed a quarter of a century ago, and for this improve- 
ment in the health of printers new methods of printing mu»t 
receive some of the credit. It is just possible that all cases 
of lead poisoning in printers arc not recognised, for the pre- 
sence of a blue line on the gums, which is of such useful help 
in the diagnosis of plumbism, is frequently absent in printers. 
In the Annual Report of the Principal Lady Inspector of 
Factories for 1906 attention is directed to the absence of a 
bJne line on the gums in 33 women and female young persons 
engaged in printing, in several of whom there were other 
^'mptonos su^estive of lead poisoning. The absence of a 
blue line on the gums is a circumstance which ought to be 
borne in mind by medical men and confirmed or otherwise by 
experience 

it is undesirable that open metal-pots should be in a 
general room where type-casting, type-setting, and machinery 
arc all at work. The pots should be hooded and have flues 
attached to them so as to carry away the fumes into the out- 
side air, care being taken not to distribute the fumes too near 
thewindowsofdwelling-housesorworkshope. Incleaning the 
flues the men should wear respirators, and, where possible, 
the duttt should be kept sprayed with water. One cannot 
too strongly impress upon printers the necessity there is for 
having the workrooms well ventilated. In places where the 
ordinary hand type is used, the type should be cleaned by 
means of steam and boiled after usage. Frinters should 
avoid eating witli unwashed hands. 

Printing by hand is on the decline. Stereotyping and lino- 
typing are replacing it. The hurry of the age requires that 
newspapers should be printed quickly. There arc several 
fast printing machines by which this can be done. By 
means of stamped cylinders, stcreolypiitg makes it possible 



METALLIC POISONS, DUST, FUMES, ETC. i8i 

to print without resorting to individual type. Rolls of paper 
miles in length feed the machines, so that thousands of news- 
papers can be thrown off in a very short space of time. 
Type-settin{> machines capable of automatically distributing 
the type, and the various forms of linutypc machines, have 
certainly diminished the amount of lead poisoning in printers, 
but for finish and as a work of art it cannot be SAid that 
linotyped printing is cquaJ to that done by hand. 



Glass Potiskmg 

Glass and crystal, when cut and made into the \'arious 
products for which there is a market, have to be polished. 
This is usually done by means of re%'olving brushes running at 
high speed. Rouge or putty powder mixed with water is 
allowed to fall on the revolving brushes. Putty powder con- 
tains 38-39 per cent, of oxide of tin and 6S-70 per cent of 
oxide of lead, and as the revolving brushes run at great speed 
a good deal of spray is thrown off, which falls upon the 
clothes and hands of the workers and also upon the floors 
of the workrooai. The liquid dries on the floor, and subse- 
quently, owing to the traffic in the room, the putty powder 
rises into tlie atmosphere as fine dust and is inhaled by the 
workpeople. As to the harmful effects of putty powder on 
glass polishers I had abundant evidence when on the Dan- 
gerous Trades Committee of the Home OfFice. Several of 
the MTorkers 1 examined had been obliged to give up work on 
account of paralysis of the hands and wrists, others had 
suffered from severe colic. A few deaths from saturnine 
encephalopathy were reported to us. 

Various substitutes have been tried for rouge and putty 
powder, but as in some of the substituted powders Prof. 
Thorpe found arsenic to the extent of 0*13 per cent esti- 
mated as arsenious acid, this was only replacing one poison 
in the powder for anotlier and had, therefore, to be aban- 
doned. The employment of harmless rouge powders 
should be encouraged by every possible means, and surely 
the resources of chemistry arc equal to supplying something 
that will not poison the men. In France metastannic acid 



iSs 



DISEASES OF OCCUPATION 



powder has been found to be particutarty serviceable. In the 
glass works at Baccarat it has been used for the la^t fifteen 
years with satisfactory results. Since in England the putty 
powder has been made containiiif; smaller quantities of lead, 
the number of cases of pluoibism has been fewer, but part of 
this is due to improved methods of polishing, better aspira- 
tion, and greater cleanliness on the part of the workpeople 

J}yg Works 

In dye works where yellow colours arc got from chromatc 
of lead, the dust given off by the yam is extremely injurious. 
The women who handle and puti the yam become covered 
with yellow dust. They become anxmic and complain of 
severe headache. Many of them have sharp attacks of colic, 
while in others the more serious forms of ner\'e disorders are 
met with. In a dye works in which during the cold weather 
the running of the ventilating fan was stopped, there occurred 
quite an outbreak of lead poisoning — one of the young 
women unfortunately died from acute plumbism. On re- 
starting the fan the health of the operatives again improved. 
Means should be provided in all dye works for the with- 
drawal of the dtist away from the workers ; the women should 
wear overalls and caps, otherwise their hair becomes covered 
with yellow dust. 

In calico printing lead poisoning sometimes occurs owing 
to the printing of colours on the cotton cloth by means of 
lead salts. The danger is met with in the drying-rooms, and 
is due to the inhalation of the dust given off during handling 
of the dried goods. 



House, Coach, and Skip Pointing 

Painters are extremely liable to suffer from lead poisoning, 
especially if working in close and confined spaces. They 
become affected by inhaling dust during the sandpapering of 
surfaces, the stithe given off during the buming-ofT of old 
paint, also by absorption through the skin, especially if it is 
cracked. Freshly painted surfaces give off emanations which 



METALLIC POISONS, DUST, FUMKS, ETC. 183 

are harmful to many pernons. Some writers r^ard these 
emanations as hurtful owing to the turpentine with which the 
paint is mixed, but experience and experiment show that 
they contain truces of lead. If metal boxes freshly painted 
with white lead arc placed in a glass jar, and the air aspirated 
from the boxe<; is carried through a 10 per cent solution of 
sulphuric acid, traces of lead are invariably found. It is only 
a trace of lead that is found, for by the delicate test dis- 
co\'ered by Professor Trillat, of the Pasteur Institute, Paris 
the presence of the metal can be proved. An acetic acid 
solution of tctramcthylatc of diphcnyl methane gives a beauti- 
ful blue colour with binoxide of lead. This test will demon- 
strate the presence of one three-millionth part of lead so long 
as steps have been taken to convert the lead previously into 
binoxide by oxidising the lead salt by an alkaline hypo- 
chlorite solution. To such emanations therefore, as are given 
off from a freshly painted surface part of the lead (loisoning 
of painters must be due. Until recently we did not know for 
certain in what form the lead is present in the enunations, 
Lf., whether molecular or as vapour. Animals that have 
been placed in freshly painted chambers and muezlcd so as to 
ob%'iate all chance of licking the surface or of eating the 
paint suffer from colic, and men and women who have slept 
in freshly painted rooms have presented symptoms of lead 
poisoning. 

1 have recently been consulted by a house-painter who had 
been suffering off and on from lead colic, but who has latterly 
become very ill, especially after mixing the white lead with 
oil to make paint and also after using the paint. The 
mixture emitted .such a disagreeable odour that he fre- 
quently vomited after using it On some occasions il was 
so disagreeable that he could not go near the paint. The 
oil mixture without the white lead had not an agreeable 
odour, but this was as nothing compared witli that emitted 
by the paint The man's illness was the result of the 
inhalation of vapours given off from the paint He would 
begin the day's work feeling quite well, but as the day went 
on headache developed, and before leaving his shift he would 
vomit and feel extremely ill. It was not the turpentine in 



i84 



DISEASES OF OCCUPATION 



the oil that made him Ml, for the oil and turpentine mixture 
aIor>e did not upset hire. Evidently some peculiar com- 
pound is formed between the tcrcbinthatcd oil itnd the 
white lead, inhalation of which is the cause of the symptoms 
of poisoning observed in painters. That such emanations 
from freshly painted surfaces occur has been proved by the 
experiments of MM. Heim and Hcbcrt, also by M. Trillat, 
of the Pasteur Institute.' Heim and Hubert exposed 
cultures of a mould — PenictUium glautum — to air in closed 
bell-jars under different conditions, viz., (*») air alone ; {b) air 
which might become infected from drj- white lead ; and {e) 
air in contact with fresh paint. In (a) the mould developed 
by the third day. in {b) shortly after the third day, while in 
(f) the delay was considerable, and only a few colonies of 
growth appeared. In another experiment, the gfrowth of a 
different mould — A$pergiltus niger — was arrested by emana- 
tions from a mixture of lead and oil. In another series of 
experiments, Trillat found that dry white lead gave forth no 
emanations to check the growth of cultures, nor did the oil 
mixture which was, used for grinding the while lead, but the 
folly completed paint checked growth. Emanations from paint 
are harmful to vegetable oi^anisms, and experience shows 
that they are also harmful to human beings. A guinea-pig 
placed in a large bell-jar, the air of which had passed over 
freshly prepared paint, died eighteen hours afterwards, and 
in the lungs there were signs of acute congestion. While 
turpentine is itself toxic and may contribute to the pro- 
duction of some of the symptom.s — headache, lassitude, and 
sickness — experienced by persons sleeping in freshly painted 
rooms, additional experiments by Trillat showed that when 
the paint was made with zinc oxide instead of white lead, 
although the same amount of turpentine was present, the 
animal took no harm. There is some peculiar combination 
formed at the time between the white lead and oil mixture, 
inhalation of which is dangerous. 

Every year sex'erai deaths are reported among painters 
from plumbism. As notification of cases of lead poison- 
ing in house- painters " is not obligatory," it is difficuU to 
■ Lt youmai OffieUl, 4 Aout, 1907, p. ydA. 



*i*w^ns ffi-gai*" 



METALLIC POISONS. DUST, FUMES, ETC. 185 

obtain satisfactory data in regard to the amount of plumbtsm 
in the trade Sooner or later compulsory' notification of all 
eases of industrial lead poisoning instead of, as at present, only 
those trades which come under the influence of the Factory 
Acts, will ha^-c to be made to the Home Office Although not 
obligatory, l8l cases of lead poisoning in house-painters and 
plumber* were reported to the Home Office in 1906, includ- 
ing 3G deaths, compared with 163 cases for the previous year, 
including 28 deaths. A special form »ummarising the infor- 
mation under the Factory Act, 1901. which requires notifica- 
tion of industrial poisoning by medical practitioners, has been 
issued by the Home Office, and white the need for keeping 
the matter before medical practitioners will probably be 
lessened by the incllI^ion of certain notifiable industrial 
diseases mentioned in the third schedule of the Workmen's 
Comj^ensation Act which came into force on July I, 1907. 
upon Ihe certifying surgeon will be laid the important duty 
of certifying whether a workman is suffering from a disease 
mentioned in the schedule, for on the "grunting or with- 
holding of such certificate depends (subject to appeal to 
a medical referee) the power of the workman to claim com- 
pensation," "as if tlie disease . . . were a personal injury by 
accident arising out of and in the course of that employ- 
ment." The fact that the Workmen's Compensation Act 
has come into force in no way removes the obliga- 
tion imposed upon medical men of notifying lo the 
Chief Inspector of Factories cases of industrial lead 
poisoning. 

The processes of house painting which are unhealthy are 
the burning-ofT of old paint and, after the prime colours 
have been laid on and the puttying done with white lead, the 
smoothingof the flat surfaces by means of sandpaper. Fume 
and dust are to be avoided, and in washing off old paintit^ 
by means of caustic potash care must be taken that the skin 
of the workman's hands is not cracked. House-painters 
should not hold in the palm of their left hand white paint for 
laying un surfaces by means of a jialette knife. If there are 
cracks in the skin tlicreis the risk of absorption. lnonchou5c- 
painter 1 found several small inflammatory indurations under 



DISEASES OF OCCUPATIOK 



the finger-nails. Painters sufTcr more from "lead gout" in 
London and the South of England tKan they do in the North. 

In L'Bcko Midical du Nord, September 9, 1906, Dr. D. 
Verhaeghc gives an interesting account of 'an inquiry made 
into the health of the house'fuuiiters of Lille. Of 131 house- 
painters he found 6S to be in good health, 45 in fair health, 
and 18 in bad health. The period of life during which tlic 
men seemed to ail most was between 30 and 35 years of age. 

There was a close correspondence between the ^es of the 
men and the length of time they had worked at the trade. 
An attempt has been made by some French writers to 
explain the symptoms of lead poisoning in house-painters 
by their excessive use of alcohol. Far from underrating the 
prejudicial influence of alcohul in precipitating a patient into 
plumbism I have always maintained that it aggravates the 
illness, but it cannot in any way be regarded a.s the cause of 
plumbism, nor i.s it quite true that house-pain ter-i arc a more 
intemperate class than other workmen, although 27 per cent. 
of the painters in Lille admitted that they took alcohol. It 
is not stated that they took it to excess. More Uian one-half 
of the workmen suffered from colic and digestive troubles. 
The few workmen who pass the age of 50 are men who have 
been careful in their habits and cleanly in their person. 
Before they reach the age of SO the intemperate men 
are weeded out Of the 131 house-painters examined, 90 
supplied information concerning their families. Between 
them these 90 painters had had 467 children. Of those 10/ 
had been stillborn and 93 died under 2 years of age, i.e., 
among painters the still-births formed ZZ'^ per cent, of the 
birth-s while for Lille generally the still-born children only 
formed S'2 per cent. Verhae^he supplies statistics compar- 
ing the number of still-births before the fathers adopted house 
painting as a profession and after having done .so, and he found 
that before the fathers became house- painters the still-births 
formed 6"^ per cent of the births, and afterwards 2i"05 per 
cent In Lille, house painting is apparently not so organised 
a trade as it is in this country, where the men go to it as 
apprentices and few leave it to change into another trade ; 
but taking Verhaeghe's facts as they are, they point in an 



I 



n Mi . ina^TT 



METALLIC POKSONS, DUST, FUMES, ETC. 187 

unmistakable manner to the occupation of the Tather exer- 
cising a baneful inducncc upon the life of his i>rogeny. 

The mixing of paints and colours is equally an unhealthy 
occupation, unless means are taken to obviate dust. The 
grinding and mixing of paints and colours, which are 
admitted to be dusty occupations, accounted for 27 cases 
of lead poisoning in 19061 On July 9, 1906. Draft Regu- 
lations for the Faint and Colour Trades were issued from 
the Home Office These deal with the mixing, grinding in 
oil, and sifting of dry lead colours and the provision of 
exhaust draughts to carry away dust, monthly medical exami- 
nation of the workpeople, the insertion in a Health Register 
kept in the factory of the names of all workers in lead 
processes, wearing of overalls and washing of the same once 
a week, provision of washing conveniences, and the prohibition 
of the employment of women and young persons in the 
manipulation of lead colours in the dry state or in the grind- 
ing of the colours in oil. It la anticipated that much good 
will follow adhesion to the Regulations. 

Coach painting is often carried on In conBned spaces. A 
well-finished coach will frequently have received as many as 
eighteen coats of paint before the varnish is applied. The 
colours sometimes contain large quantities of lead ; so, too, 
do the " driers." Coach-painters become the subjects of lead 
poisoning by inhaling the dust when smoothing painted 
surfaces with sand[>uper. 1 had recently a coach painter under 
my care suffering from double wrist-drop, who had become 
poisoned by painting Iron coach frames before they had become 
quite cool. For the la^t eight years the following has been 
the number of cases of lead poisoning in coachmakers notified 
to the Home Office, In 1906, 85 cases, and for the previous 
seven years 56, 49, 74, 63, 65, 70, and 65 respectively. The 
notifications for the year 1906 show a considerable increase 
over those of the year 1905 : 32 of the cases occurred in rail- 
way carriage and wagon works, 10 in motor-car works and 43 
in coach and carriage works throughout the country. Part 
of the increa.<» in the number of cases of plumbism in coach- 
painters is due to the prosperity of the motor-car industry, 
and is the result of inhalation of the dust evolved during 



i8« 



niSEASES OF OCCUPATION 



Che sandpapering of the dried coats of paint Painters of 
perambulators and men employed in malting and painting 
railway signals are liable to plumbism. 



r*_r^^i 



'4 



Sv&stiiutes for Whiu Ltad 

Reco^ising the harrofulncss of white lead, many cflTorts 
have been made, both at home and abroad, to replace it by 
other pigments. When sitting on the White Lead Cooi' 
mission it was one of the subjects to which we gave par- 
ticular attention. Several inquiries were made, but u-e found 
that among house-painters there was no such unanimity of 
ojMnion as called for a specific recommendation from tix as 
to the use of white lead for external purixees. As r^ards 
internal decoration, opinions were more in agreement that 
zinc white could replace lead carbonate A paint to hnvej 
oommcrctai value must have good coverinR power and dura*' 
bility ; it roust be capable of mixing well with oil, and above 
all it must not be too expennive. All these properties are 
possessed toa high de|;ree by white lead made by the Dutch 
process, and they are only doubtfully possessed by zinc white, 
for although mixing well with oil and possessing covering 
power, it is, so far as outdoor decoration is concerned, not m^ 
durable, and is more apt to peel off. H 

White lead manufactured by the Dutch process is composed ' 
of small globules which mix well with oil, forming a soap, 
whereas most of the other pigments are crystalline and 
only make a mechanical mixture. One of the drawbacks 
urged against white lead is that it sometimes becomes yellow 
in the presence of isulphur in the atmosphere; hence for 
tntcnial decorative puqioses a mixture of lead carbonate and 
zinc white is recommended, since the lead gives coveringj 
power and durability and the zinc whiteness. In Fiance thd 
substitution of zinc white for lead carbonate has become 
almost a national question. Bill after Bill for the total sup- 
pression of white lead as a paint for buildings has been 
brought before the Chamber of Dejiuties and passed, but 
they have been negatived by the Senate. 

It is interesting to know that as for back as 1775 Guytoo 



^ 



METALLIC POISONS, DUST, FUMES, ETC. 189 



de Morvcau, the distinguished rival or Lavoisier, suggested 
that zinc uhitt: kIkjuIcI be stubstituted for wliite lead j in 
1S35 L^claire demonstrated the comparative harmlessness 
rmtn a health point of view of zinc white and its capa- 
bility of replacing lead carbonate in the painting of build- 
ings. When Lacrosse was the Minister of Public Works 
in Paris in 1S49, he causied zinc white to be UHed instead 
of lead on Government buildings; in 185:: all thv ^r&feUM 
wen circularised by M. I'crsigny, interdicting the use of 
lead, and in 1901 thi:> was again dune by M. Pierre Daudin. 
Not one of the injunctions issued has been of the slightest 
worth. During the last six years, otiring to the large 
number of cases of plumbism in hou&e-painters in France, 
an aggressive attitude has been assumtxl by many of the 
working painters, medical men, and legislators towards the 
use of white lead. It is difficult for any legislative body to 
interfere with an old-established trade. France certainly 
solved the problem of phosphorus necrosis in lucifer match 
making by ^tubstituting the scsqui sulphide for the dangerous 
white phosphorus, but in regard tu the use of lead paints 
vtrsus zinc, opinions are still divided, and ai^uments are so 
well put forward by both sides that members of Parliament 
have a difKcitlty in coming to a determination a<< to the 
proper steps to be taken. In France there is a tendency to 
make all such industrial questions political, ajtart from their 
economic and social aspects. The Comitc Con^uttatJf 
d'Hygiine. a body to which problems relating to industrial 
hygiene are entru:ited by the Government, reported iti March. 
1901, that the manufacture of white lead had become a much 
less harmful industry owing to the E Xpert- Besan^on process 
of grjudint; and mixing the while lead in water, with the 
subsequent replacement of the water by oil as the paste 
passes on through the rollers, periodical medical examination 
of the workmen, alternation of employment, and the careful 
selection of workmen in the first instance, no intemperate 
man being received into the works. This is certainly true 
as far as it applies to the manufacture of white lead. As for 
the dangers from lead in house {tainting, the opinion has 
been cxpre!.sed that the men were themselves contributory 




190 



DISEASES OF OCCUPATION 



factors to plumbism by their intemperance and want o 
personal cleanliness, but all painters who suflTcr from plumbism 
can scarcely be pcgarded as intemperate men. 

To assist in scttlinR the question as to whether 7inc white 
can replace lead in painting the exterior of buildings, the 
results of many experiments have been made public 
France: these are, it is needless to say.pra and c*w. Mention' 
must be made of the experiments carried out by M. IJvache 
under the direction of the Society of Public Health and the 
Pasteur Institute. He states that at the end of three years, 
notwithstanding the objections of architects and while lead 
manufacturers, it must be admitted that the coalings of zJn 
exposed to the external atmosphere and to all kinds of 
weather have lasted as well as those of lead. A committee 
presided over by M. Kigolot and appointed by a syndicate 
of the master painters has watched the outside walls of the 
Pasteur Institute, and h:u; certified as to the equal resistance 
of the coatings of paint made by white lead and zinc oxide 
during the years 1903, 1904, and 1905. In consequence of 
this report the Minister of Public Works sought the opinion 
of the principal engineers of roads and bridges all over 
Fr.tnce, Of the 107 reports received, 73 support the 
opinion of the equal resistance of zinc and lead both for 
Che interior and exterior of buildings. Zinc white is t 
more expensive, but M. Livache states that the increased' 
cost only amounts to 3 fr. 60 c. in the three coatings over 
a surface of roo metres, »>., over a little more than 3CXD 
yards, and that by the addition of a small quantity of sul- 
phate of barium to give body to the paint the cost is not 
greater than white lead. It Is only right that 1 should 
interpose here the remark that in Great Britain sulphate of 
barium, owing to its crystalline nature, finds little acceptance 
with house-painters. The interdiction of white lead i: 
France is not yet an accomplished fact. The Chamber of 
Deputies has on at least twu occasions voted in favour of 
the total pfohilMtion of lead, and it remains to be seen what 
action the Senate will again take in the matter. In the 
French experiments «nc white apparently withstood exposure 
to the weather to the satisfaction of the experts, but whether 



edV 

rer^ 



3f^ 



^iP 



METALLIC POISONS, DUST, FUMES ETC. 191 

in the more trying climate of Great Britain it would have 
enduring powers equal to white lead is still not proven. My 
ovim opinion in regard to the subject, which is ba-wd upon 
the cx|jcriencc gained when a member of the White Lead 
Commission, is that white lead is superior to Einc as a pairtt 
for the exterior of buildings, but that for internal decoration 
zinc white gives as good resultK as lead. The opinion of 
many coadi- painters is simitar to my own. Experience has 
convinced them that for the interior decoration of railway 
carriages and for van-building zinc white is just as satis- 
factory as white lead. In the manufacture, too. of cornice 
poles and rings white lead is being discontinued, reliable 
substitutes having been found in zinc white and in a substance 
known in the trade as " lithopone." 



Minor Industries in which Lead is Employed 

It would be impossible to enumerate all the industries 
in which lead in one form or another is employed and in 
which plumbism may occur. Persons employed in making 
lead capsules and in Bxing them upon the corks of bottles of 
beverages and proprietary medicines become occasionally 
the victims of plumbism. In persons employed in making 
measuring tapes for tailors, also in tailors' cutters, t have 
known lead poisoning occur through the men holding the 
tape in their mouth. The manufacture of masonic clothing 
is not free from risk to health. The machine girls who bind 
the white skin with ribbon to form the apron complain of the 
white dust that is given off. This dust frequently contains 
small quantities of white lead, inhalation of which explains 
the anxmia of the machine girts, the severe headache they 
suffer from, and the blue line observed on their gums. Lead 
poisoning is met with in persons employed in tndiarubber 
works owing to the use of lead carbonate as a whitening 
agent, also in the painters of safe^ It is not necessary to 
use lead paints for safes. Non-poisonous paints give equally 
satisfactory results. There has been within recent years a 
slight increase in the number of cases of lead poisoning in 
brass works, especially in the dressing of brass castings, and 



I9a 



DISEASES OF OCCUPATION 



doe in all probability to lead Ibrming a constituent of some 
of the composittuii-t used in making bntt^. Men ctnployed 
in the tempering of tlte spiral sprinfp of railway buffers have 
occasionally siiflTcicd from plumbism. The springs are 
dipjMrd in a bath of molten melal containing lead, and during 
the process of testing the springs in a machine called a 
* scragg," Mr. Dobson, H.M. Inspector of Factories, Sheffield, 
found that the men who n-crc thus employed were specially 
liable to plumbism. 



Symfifomatology and Pathchgy of Lead Poisoning 

While of all the industries which give rise to plumbism 
the manufacture of white lead is the mo«t important, there 
are others which do not rank far behind it so far as ill-health 
of the wforltpcoplc is concerned. No matter how plumbism 
is induced, whether by inhalation of dust, absorption through 
the skin, or swallowing of soluble lead-salts, the symptoms 
are the same. One uf the principal things to bear in mind 
is that it is the continuous entrance of vcr>' minute traces of 
lead into the body rather than the occasional entrance of a 
larger dose that induces the most severe forms of plumbism. 
for it is of the nature of lead to act slowly, and thus gradually 
to undermine the health. One of the earliest s)-mptoms is 
colic, but for some time previous to the onset of abdominal 
pain it will be found on inquiry that the patient on getting up 
in the morning had experienced a disagreeable metallic taste 
in the mouth which prevented him enjoying his breakfast, 
that he felt headachy and rather sick. His features, too, had 
been altering, for his face had been gradually becoming paler 
and more expressionless. To the peculiar pallor of the face 
and the appearance of the features generally the term 
"saturnine cachexia" is applied. The increasing pallor of 
the face is associated with a degree of bloodlessness which 
tends to become worse. After a few weeks' exposure to lead 
in a white-lead factory I have seen young healthy women 
not only lose their ruddy appearance and become quickly 
pale, but die from saturnine encephalopathy within four 
montlu of taking .up the work. Some persons 




4 






METALLIC POISONS, DUST, FUMES. ETC. 193 



predisposed to plumbism than others, but no one is immune. 
There ts both a personal and a family idiosyncrasy to lead 
poisoning. People who are naturally pale and anecmic, who 
cannot e%t well or who arc intemperate in the use of alcohol, 
are more liable to plumbism than others. Poverty and its 
accompaniments predispose to it, so does the absence of 
personal cleanliness. Young adults are more liable to lead 
poisoning than men and women of maturer age. Females, 
in my opinion, are not only more susceptible than males, but 
in them the malady is more apt to assume the worst form, 
viz., the cerebral type, or what is called lead or saturnine 
encephalopathy. 

Af^er having experienced headache for days or weeks, and 
perhaps having sufTcred from constipation, the patient is 
seized, often rather suddenly, with severe pain in the abdo- 
men, in the neighbourhood of the navel, attended by vomiting 
and usually accompanied by constipation. The pain is not 
due to constipation, for It does not disappear when the bowels 
have been freely moved, and besides, instead of constipation 
there may be diarrhcea. So severe in some instances is the 
colic that it is difficult to restrain the patient. The pains 
come and go, and arc therefore paroxysmal in character, or 
they arc more constant and arc so severe that the patient 
writhes in agony. Occasionally he gets relief by the external 
application of warmth and gentle pressure, in other instances 
the patient cannot bear to have the abdomen touched. The 
pain is of two kinds. There is a superficial and there is a 
deep-seated pain, either of which may continue for two or 
three days, but gradually becoming less. Once the extreme 
acutcness of the pain has subsided, it ts usually found that 
the pain, as tested by pressure of the examiner's hand, is 
worse on one side of the abdomen than tlie other, and that 
pressure along the course of the pncumogastric ner^-e in 
the neck is always more painful on the same side as that 
on which the abdominal pain is more severe. When the 
abdominal pain is superficial it is usually paroxysmal and 
aggravated by pressure: on the other hand, when the pain 
is more deeply situated, it is more constant, and is rathn' of 
the nature of a dull aching than acute pain. The belly, as a 




194 



DISEASES OF OCCUPATION 



rule, is retracted. The pupils are frequently unequal. The 
pupil of the eye of the same side as that on which the 
abdominal pain as elicited by pressure is the more severe 
is usually, but not invariably, the smaller of the two. The 
pubc at the wrists is unetiual, that on the side of the 
abdomen which is the more affected being sometimes the 
stronger, sometimes the weaker of the two. While the 
abdominal pain persists the sulphucyanidc of potassium dis- 
appears from the saliva, but on the subsidence of the colic 
there is a reappearance of the sulphocyanidc in the saliva. 
The presence of this salt in the saliva is demonstrated by the 
development of a reddish- brown colour on the addition of] 
a small quantity of a weak solution of Liquor Ferri Per-j 
chloridi to the saliva. 

It is difficult to say what the colic is due to. In animals 
that have died from acute lead poisoning I have found the 
small intestine so firmly contracted in places by muscular 
spasm as to completely obliterate the calibre of the bowel. 
Spasm in all probability plays an important part in causing 
pain, but what is the cause of the spasm? It may be that 
lead primarily acts upon tlie nerve ganglia in the abdomen, 
or upon the small blood-vessels, and by causing them to 
contract shuts off some of the blood supply and thereby 
induces muscular spasm, or it may be that lead acts as a 
poi;»on to the intestinal muscular libre and by its direct 
action causes the small intestine to be constricted in some 
places and not in others. To this cramp-like contraction 
the colic is in all probability due. 

Lead colic has sometimes been mistaken for appendicitis, 
also appendicitis wrongly diagnosed as lead colic, and patients 
exjxjsed to the risk of a surgical operation when medicinal 
treatment would have sufficed. With the greatest care pos- 
sible it is not always easy to dlRerentiate between appendicitis 
and lead colic. The presence of a blue line on the gums is 
suggestive of saturnine poisoning, but a house-painter or any 
other person who is working in lead is just as liable to 
appendicitis as other people. The difiiculty specially arises 
when the pain of lead colic is referred to the i1eo-ca:cal 
rt^ion, !>., low down in the right side of the abdomen. 




METALLIC POISONS, DUST, FUMES, ETC. 



Some physicians maintain that lead as a toxic agent is of 
itself capable of causing appendicitis, since perforating 
appendicitis has occurred in plumbism, In cases of obscure 
abdominal pain the cause of which is not clear, or where a 
history of lead is obtainable, an opinion should not be given 
until after very careful examination of the patient and due 
consideration of all the facts bearingupon theillness. A »low 
pulse, absence of fever, vomiting and a diminished area of 
hepatic dulness point to lead colic as against appendicitis. 
The location of pain in the neighbourhood of the umbilicus 
is in favour of plumbism. Although this is the usual seat 
of the pain in lead colic, the pain may not remain confined 
Co this spot but radiate pretty well all over the abdomen. 
The co-existence of vagal pain in the neck, brought out by 
pressure, would confirm tlie suspicion of tlie abdominal pain 
being due Co lead colic. In the abdominal type of lead 
poisoning, colic, vomiting and constipation are usually present 
together, and these three symptoms constitute the saturnine 
triad. During the height of the pain the radial pulse often 
becomes so small as to be almost imperceptible ; in other 
instances it is hard and resistant The pulse frequently falls 
as tow as forty to the minute It is seldom that patients die 
during an attack of lead colic 

As an indication of the difficulty of making a diagnosis in 
the acute abdominal illness of a lead worker, let me mention 
the following. A man about fifty years of ^e, but who 
looked much older, a lead worker, was admitted into the 
Newcastle Royal InRmiary under my care, sufiering from 
(kcal vomiting, a dry parched tongue, and constipation. He 
was sent into the Infirmary under the cate of a suipcal 
colleague for operation, as the man was supposed to be 
suffering from intestinal obstruction. As the patient was 
extremely ill and in a state of collapse, operation wa$> 
deferred. When seen by me on the following day there were 
the symptoms already mentioned, and with these there was 
present a well-mart<ed blue line on the gums. The vomiting 
continued, and as no urine had been passed for two days 
a catheter was passed into the bladder and a small quantity 
of urine removed. This contained albumen. The diagnosis 



198 



DISEASES OF OCCUPATION 



from the factory. Malassez, a French physician, althougt 
admitting that anaemia may rapidly develop, is of the 
opinion that the bloodlcssncss of lead workers is projjor- 
tional to th<: length of time they have spent in the works. 
According to Malassez, Uie blood of a painter, which at the 
cummcnccmcnt of his occupation contains 4,500,000 red 
blood corpuscles, will after five years contain 3,700,000, at 
the end of twenty >'ears 2,600,000, and at the end of thirty 
years 2.2O0.000 red corpuscles. 

I^ead as a poison strikes h.ird the blood-maktng powers of 
the body. It is probably by this fact and the recurrent 
demands made upon the system by menstruation that the 
greater susceptibility of women to pliimbism is to be 
explained. The idiosyncrasy is not confined to women 
alone, for I find it present in the female sex of most 
animals. The menstrual flow is usually increased in female 
lead workers, but occasionally there is amcnorrhcca. Women 
who are the subjects of plumbtsm even so slightly as not 
to present symptoms, exhibit when pregnant a marked 
tendency to abort. Several animals under my care have 
in experimental plumbism miscarried. Lead destroys the 
reproductive powers of both men and women, but its special 
influence upon women during pregnancy is the cause of a 
great destruction of human life. A lar^e percentage of the 
children burn to lead workers die within the first few months 
of life. The percentage of still-births is as high as mis- 
earriages arc frequent. In towns where the drinking-water 
has become contaminated by lead the tendency to mis- 
carriage often assumes an epidemic form. With lead 
poisoned pregnant women who had been in tbc habit of 
miscarrying, i found that the only possible way for them 
to go to full term and have a living child was to get 
them to retire from the lead works altogether. Several 
women on my recommendation did this: they went into 
the country and took up work in the open air. While 
following a healthy occupation these women, after having 
fre<iuently miscarried when working in lead factories, would 
have two or three living healthy children, but circumstances 
necessitating the return of these women to town, and 



METALLIC POISONS, DUST, FUMES, ETC. 107 

Mention has been made of the pccuhar pallor of the face 
in lead poisoning. This is due to ana;mia. On examining 
the blood microscopically the red corpuscles are found 10 
be fewer in number than tn health. Instead of there being 
5,000.000 red blood corpuscles per cmm. of blood, as there 
should be in health, there may be two-thirds or only oiie-half 
of the normal number. In one of my lead poisoned patients 
there were 2,700,000 coloured corpuscles and to.ooo white 
corpuscles. Accompanying this diminution in tlie number 
of the red blood corpuscles there is a corresponding fall in 
the amount of ha:moglobin or colouring matter of the blood. 
The white corpu.scles are not increased. Gravitz has drawn 
attention to a peculiar structural change undergone by the 
red blood corpuscles and brought out by the use of special 
Staining reagents. They exhibit a distinctly granular 
appearance, due to the minute granules taking on basic 
aniline stains. The white corpuscles do not usually show 
any profound structural change or percentage numerical 
alteration. In the case just referred to the colourless 
corpuscles were distributed as follows, vis.; — 



Pdymorphonuclcar 
Small lymphocytes 
Laigc 
Eosinophils cells . .. 



66 per cent. 

6 „ 
8 . 



la llcallh 

60-jo per cent. 



['S-30 



The cosinophile cells were slightly in excess. Occasion- 
ally a few nucleated red blooH corpuficles are found in 
plumbisra. The anaemia has been said to be proportional to 
tlic Icngtli of exposure to lead, but this is not always the 
case, for I have seen young women become markedly pale 
in a very short time. It is the function of the red blood 
corpuscles to absorb oxygen from the air in the lungs and 
to carry this gas into all the organs and tissues of the body. 
A deficiency in the number of these corpuscles implies im- 
perfect oxygenation of the system, with all its con^xjuenccs. 
Workers in lead may, as stated, become ana:mic at an early 
date after exposure to lead: once it is developed the pallor 
remains for a long time, even after the patient's rctircoenl 



\ 



20Ct 



DISEASES OP OCCUPATION 



nancies, but only one or the pregnancEes ended in s live 
birth. He also iiientJons tht; case of a woman who at the 
age of twenty married a house-painter, and in course of 
time gave birth to a male child, who lived until four years of 
age. A year after this she entered a lead foundry. Until 
then her menstruation had been r^ular. Subsequently she 
became the subject of lead paralysis, both hands were 
aflcctcd, but although there was marked ansL-mia, there was, 
a» is frequently titc case in type-ntalcers and printers, no blue 
line on the gums. During the eight years she worked in the 
foundry she had S oiidcarriages and only once a living child, 
who died 6vc weeks after birth. It is an interesting fact 
that while a man who has sufTered from phimbism takes a 
long time to recover, even after witlidrawal from the lead 
works, a woman who has been a lead worker, and in whom 
during all the period she was in the factory each pregnancy 
ended in a mbcarn'agc or a still-birth, will, if she gives up 
working in lead, probably go to the end of term in her next 
and succeeding pregnancies and give birth to healthy children 
who survive. The effects of lead in this particular direction 
are worst when both parents are aiTectcd, next when it is the 
mother alone who has been brought under the influence of 
lead : but there is evidence to show that lead impregnation 
of the male is also extremely prejudicial to the offispring. 
Renncrt has attempted to express in statistical terms the 
varying degrees of gravity in the prognosis of cases in which 
at the moment of conception both parentt are the subjects 
of lead poisoning, also where one alone is affected. The 
malign influence of lead is reflected upon the fortus and on 
tbe continuation of the pr^^nancy 94 times out of 100 when 
both parents bavc been working in lead, 92 times when the 
mother alone i<t affected, and 63 times when it is the father 
atone who has worked in lead. Taking 7 healthy women 
who were married to lead workers, and in whom there was a 
total of 32 pregnancica, Lewin tells us that the results were 
as follows: II miscarriages, i stili-btrth, 8 children died 
within the first year after birlh. 4 in the second year. 5 in the 
third, and I subsequent to this, leaving only 2 children out 
of 32 pregnancies as likely to live to manhood. In cases 



H 




METALLIC POISONS, DUST, FUMES. ETC. »i 



where women have had a series of miscarriages !»a lon[; as 
llicir husbands worked in lead, a change of industrial occupa- 
tion on the part of the husbands restores to the wives 
normal child-bearing powers. How is it that lead cxerdses 
such a harmful influence upon reproduction? That lead has 
strong abortifacicnt powers the cases cited above amply 
indicate. It is knowledge of this circumstance that causes 
females of the lower ranks of life to resort in expecting 
motherhood to the uae of diachylon pills (lead) for the 
purpose of inducing abortion, an ill-advised procedure and 
a dangerous line of treatment, since it has in too many 
instances caused the death of the woman herself. Lead 
causes abortion probably by acting upon the unstripcd 
muscular fibre of the womb and inducing spasm. The poison 
also passes from the blood of the mother through the placenta 
to the fa;tus in utcro, and by killing the fu:tus it thus 
indirectly brings about abortion. That lead passes thus 
from a woman to the offspring in her womb is confirmed 
by the detection of lead in the liver and nervous system of a 
still-born child upon whom 1 made an autopsy. The infant 
was the offspring of parents both of whom were white lead 
workers. The same remark applies to aninmls. In the dead 
fcetuses of some of my rabbits that had been fed with lead 
Professor Bedson on chemical analysis found traces of lead. 

Following up this subject, the experiments of Balland arc 
too valuable to be omitted. On one occasion I had the 
breast milk of a female lead worker who was nursing her 
infant examined for lead, but without success— probably 
because just at that time the woman was not actively 
engaged in the lead factory. Balland administered daily 
small quantities of lead to a bitch who on the day previous 
to the special feeding had given birth to seven puppies. 
These animals were entirely nourished by the mother's milk. 
For the first few days after commencing the lead all went 
well, then subsequently the puppies became an<emic, one or 
two of them seemed to suffer and become weak in thetr 
limbs and dwindled. Two of them were killed 25 days afler 
their birth, and chemical .inalysis revealed the presence of lead 
in their viscera to the extent of 5 to 10 milligrammes in one 



202 



DISEASES OK OCCUPATION 



and 40 to 45 in the other. Balland's ocpcrimcnts clearly 
demonstrate the transmission of lead to the nursling through 
the mother's milk and the sad consequences which follow. 

Mention has been made of the fact that the children of 
lead workers, if bom alive, are frequently ill-nourished and die 
shortly after birth, and that this is particularly the case 
where the mother is the subject of lead toxKitnia. Many of 
the children die in their first year from convulsions. A Ithough 
lead destroys the offspring in iitero and prevents pregnancy 
running its proper course, I have found, comparatively 
speaking, fewer instances of idiocy and imbecility in the 
children of lead workers than might have been anticipated. 
I have seen both cretinism and imbecility in infants in whom, 
as there could have been no possible influence of alcohol, 
and presumably none of syphilis, the occupation of one or 
other parent as a lead worker must have determined the 
imperfectly developed nervous system of the child. The 
lai^ number of miscarriages and still-births and the short 
life that is meted out to the children of lead workers show 
that some peculiarly baneful influence had been stored up in 
the germ cell of the female and sperm cell of the male before 
impregnation, whereby in due course life is hit so hard in 
the earliest months of development that it cannot continue, 
for such is the blighting power of lead. Siilp^triire and 
Ricftre are large hospitals in Paris set aside for the reception 
and treatment of nervous diseases. The experience of the 
physicians of these institutions is unrivalled. One of the 
physicians, M. Roques. speaking of the degenerates found 
in these hospitals, says that slowly induced lead poisoning 
on the part of both parents or in one or other of them is 
not only a cause of repeated abortions, high percentage of 
still-births and high death-rate of infanti;, but is the cause of 
con\iilsiDns, imbecility, and idiocy in many of the children 
who survive the first year of existence. Of 19 children bom 
to parents who were lead workers, Renncrl found that I 
child was still-born and that 17 were macroccphalic. In his 
studies upon hereditary degeneration and idiocy, Boumcville 
places house-painters in the unenviable first rank of the 
occupations followed by parents of mentally weak children. 



4 

I 

i 



METALLIC POISONS, DUST, FUMES, ETC 303 



Out of 87 cases relating to unhealthy trades, 51 were cOrt- 
nccted with white lead in some form or another, while 
syphilu was only responsible for 19. I am of the opinion 
that there is a larger amount of mental degeneracy in the 
children of lead workers in France than there is in Great 
Britain. It would seem, therefore, as if tiiere were other 
contributory causes in operation than working in lead, but of 
these proof h difficult to obtain. 

Lead acts directly and indirectly upon the kidneys. liver, 
and the nen'ous s)'stem. In old standing case;; of ptumbism 
the urine contains albumen and the kidneys after death arc 
found to be contracted. Interstitial nephritis has therefore 
come to be regarded as the typical kidney lesion of 
phimbism, but in the early sta};es of the malady It is the 
epithelium of the tubules and the glomerular epithelium that 
are primarily affected. It i.s not uncommon to find albumen 
in the urine of persons who are suffering from their first 
or second attack of lead oolic, and it may disappear on 
subsidence of the pain. In young women who have 
succumbed to saturnine encephalopathy a few months after 
having worked in a lead factory I have invariably found 
tubular nephritis, and the same holds good of animals to 
vhom lead had been given in the food. Since in plumbism 
traces of lead arc usti.illy found in the urine, it is natural to 
suppose that lead, which is a foreign substance, on its 
elimination by the kidney would induce structural changes 
in these organs, and as the glomeruli and the epithelium of 
the tubules are the most scnsiti\x parts, that these would 
suffer first. Albumen therefore may appear in the urine 
in plumbism under two different circumstances. It may be 
transitory and point to a curable condition, or it may be 
permanent and an indication of diseased kidneys. When 
the kidneys become affected there is frequently complaint of 
severe headache and loss of sight due to ura:mic retinitis. It 
is to be remembered, however, that loss of vision may occur 
in lead workers witliout any indication of the kidneys being 
affected, also that lead is capable of lying latent in the 
body for a few years and then, unexpectedly and in a way 
difficult to expUin, of giving rise to fresh symptoios of 



ao4 



DISEASES OF OCCUPATION 



poisoning, I have recently had a good illustration of this. 
A female patient, M. 1'., aged 36, was admitted into the 
Infirmary undtfr my care owinR to severe Jieadache, paralysis 
of the muscles of one eyeball, and defective eyesight. She 
was a married woman, the mother of six children, one of 
whom died when young. She had also had three miscarriages. 
I recognised her as an old patient who before her marriage, 
while a white lead worker, had seventeen years previously 
been thrice under my care in the same ward on account of 
lead colic and ultimately saturnine encephalopathy followed 
by blindness, which persisted for several weeks, She made a 
good recovery, never returned to the lead works, but married 
a few yean? afterwards, and beyond having her family had 
enjoyed good health until shortly before her rcadmission into 
the Infirmary. Although the patient had not been brought 
during her married life under the influence of, or even into 
contact with, lead to her knowledge, she being the only one 
of the family who was ill, I took the view, in the absence of 
syphilis and other causes, that her headache and eye symptoms 
were the result of lead poisoning, and on a chemical exami- 
nation of the urine being made by Professor Bedson, lead 
was found therein. As the most careful Inquiry failed to 
elicit the possibility of any new source of poisoning, and 
under treatment all the symptoms improved, including the 
disappearance of lead from the urine, I cannot but regard 
the ca^e as one of lead poisoning relit by the dissolution and 
reabsorption of tlie metal which had for seventeen years lain 
dormant in the tissues. This is the longest latent case of lead 
poisoning that 1 know of. Occasionally it lias happened in 
patients sufTering from obscure forms of paralysis that the 
admin istratton of potassium iodide has been followc<l by the 
development of serious symptoms which ended in death, and 
which the data of a post-mortem examination and the facts 
obtained from relatives showed to have been due to chronic 
[^umbisni, that had not revealed itself by any symptoms 
until the advent of the paralysis. It remains to be seen how 
far the Workmen's Compensation Act can apply lo cases of 
long latent lead poisoning. It is clear that the greatest care 
wilt have to be exercised liothtu pressing and opposir^ a claim. 






METALLIC POISONS, DUST, FUMES^ ETC. 205 

Apart from causing albuminuria, plumbism alters the 
composition of the urine in other respects, so that in 
doubtful cases the suspicion of lead intoxication would be 
strenffthened by detecting red or blue indiean in the urine. 
To obtain the reaction equal quantities of a patient's urine 
and hydrochloric acid are mixed together, and to this a 
smaller quantity of chloroform is added and the test-tube 
shaken. If the chloroform becomes blue the urine contains 
indfcan or blue indigotinc : should it become red, the colour 
is due to a product which is the outcome of the oxidation of 
indigotinc, and is named indirubinc. I have invariably found 
indican in the urine of patients suffering from lead poisoning, 
and while it is occasionally present in the urine of persons 
other than those suffering from plumbism, indicanuria in 
lead poisoning is so much more constant that it is of assis- 
tance in making a diagnosis when other symptoms and signs 
are deRcicnt The test is simple and is easy of application. 
The best proof that a patient. is suffering from plumbism is 
the detection of lead in the urine on chemical analysis, but its 
absence is no proof of the contrary. 

Lead is thrown out of the system in the faces as well as 
by the urine. To Dr. Dixon Mann we arc indebted for a full 
account of the elimination of lead by the intestinal canal. 
Several methods for the detection of lead in the urine are 
recommended ; many of them are rather complicated, and 
can only be carried out satisfactorily in a chemical 
laboratory. It is not necessary for diagnostic purposes 
that a quantitative estimation should be made. A very 
simple method is to suspend in the urine a small bag 
containing calcium sulphide. If there is lead in the urine 
the sulphide of calcium will become blackened, owing to 
the formation of the black sulphide of lead. 

The nervous system is peculiarly prone to be affected by 
lead. The most dangerous form of lead poisoning is that 
known a$ saturnine encephalopathy. Women are more 
liable to this form of acute poisoning than men. It is 
usually preceded by severe headache, xvhcn often without 
further warning the patient becomes convulsed and passes 
into a state of coma. Patients may die on the second or 



2o6 



DISEASES OF OCCUPATION 



third day without regaining consciousness. During; the 
attack the uriniiry secretion may (all to as low as three or 
four ounces, and it may or may not contain albumen. 
Should the patient recover consciousness and live, it is 
occasionally observed that vision is lost This toss of vision 
may be temporary or permanent It was not an uncommon 
event wl>en females were allowed to work in lead factories 
for most of those who suttercd from saturnine encephalo- 
pathy to lose tlieir sight peimanently, and thus women still 
young in years would be found hopelessly blind and maimed 
for life. This brain type of lead poisoning may occur in 
patients without warning and without any of the usual 
prodromata. such as colic or loss of power in the wrists, and 
since it develops without the co-cxistcncc of albumen in the 
urine, it is clearly not due to uraemia and kidney disease, as] 
some physicians maintain, but is the result either of the action 
of the lead itself upon the delicate ncr\'c cells of the brain 
or indirectly of the lead having primarily interfered with the \ 
function of the excretory organs, and through this circum- 
stance having produced a form of auto-intoxication. The 
opinion has been advanced that saturnine encephalopathy is 
the result of the combined action of lead and alcohol, a. form 
of mixed toxxmta, but I have seen it occur in, and be the 
cause of death of, young females who had not taken stlmu-{ 
lants at all. One of the earliest instances of this was al 
young female white lead worker who had only been in the 
factory five weeks and who had drawn only eight stoves. 
It occurs, too, in young women employed as dippers' 
assistants in potteries as early as six to eight months 
after taking up the occupation. M. Mosny, of the H6pital 
St Antoinc, Paris, attributes the cerebral symptoms of 
lead encephalopathy to acute $atumi>mcningo encephalitis. 
On a few occasions I have seen saturnine encephalopathy 
preceded by seizures which had all the features of ordinary 
hysteria. A girl comes home from her work, and it is noticed 
by her friends that she is more excitable than usual. She 
is inclined to laugh or is disposed to cry, and is unable 
to control either her movements or her fcelir^s. To her 
friendii — and ei*en to medical men who have not I 




METALLIC POISONS, DUST, FUMES, ETC. 207 

previous experience of such cases — the symptoms do not 
in any way appear to be seriouii, and yet within two days 
after the development of this toxic h>'steria the patient will 
probably be dead. The lesson to be learnt is that we must 
never alloM; ourselves to be thrown off our guard by such 
hysterical symptoms, for they are often the prelude to satur- 
nine encephalopathy, and therefore conceal a more profound 
poisoning of the higher brain centres than at iirst appears. 

I have alluded to loss of eyesight. On examining the 
e>"es there is evidence of neuro-rctinitis with or without 
ha:morrhagcs. Some oculists have attributed the retinal 
changes to kidney disease, but as similar structural changes 
are met with in patients whose urine is free from albumen, 
all cases of blindness in lead poisoning do not own a kidney 
cause. The blindness may be due to changes in the optic 
disc and retina consequent upon kidney disease or to the 
direct action of lead upon the retina, but loss of sight in 
plumbism may occur without any structural alteration of the 
reb'na. Temporary loss of vision is occasionally complained 
of by patients during attacks of acute colic, and is to be 
explfuned by either the influence of the toxa:mia or by the 
high arterial tension which may be present Sometimes only 
one-half of the field of vision is lost 

The affection of the nervous system which occurs most 
frequently In lead poisoning is " wrisi-drop." The muscles 
of the fingers, hands, and wrists become paralysed, so that 
the hands hang powerless by the side of the t>ody, and the 
patient ts in a pitiful plight, for he cannot work, much less 
feed or even dress himself There is paralysis, more or less 
complete, of the extensor muscles of the wrists and fingers. 
Although both hands arc affected, one hand — usually the 
one whicli has done more work^is worse than tJie other. 
Wrist-drop may develop rather suddenly, or it may come 
very gradually, preceded by slight pain in the muscles. 
Fain, however, is not a. prominent symptom. The paralysis 
may involve the muscles of the forearm, also those of the 
calf of the leg. All the muscles that arc affected become 
quickly atrophied. In adults lead has a special preference 
for the extensor muscles of the wrists and 6ngers, but in 



2o8 



DISEASES OF OCCUPATION 



cbtldrtn it is the muscles of the lower extremities that are 
aflfected, hence the greater frequency in children of ankle- 
drop, which is accompanied by loss of the plantar reftex, and 
is the counterpart of the wrist-drop met with in adults. 

Wrist-drop and paralysis of the inusctcs of the upper 
extremities may occur in plumbism without there having 
been colic or complaint of headache. While it is the 
extensor muscles of the hand and wrist that arc principally i 
aflfected, the flexor muscles also become wealc. Usually ^M 
in wrist-drop the supinator longus muscle escapes, but when " 
the loss of power involves also the muscles of the upper arm, 
the supinator lon^s is also found to be paralysed. In severe 
forms of lead poisoning the paralysis may involve the muscles 
of the lower extremities, also those of the trunk. Occasion- 
ally the muscles concerned tn respiration become paralysed, 
and when this occurs death ensues. Symptoms suggesting 
general paralysis are sometimes obser\'ed : memory to a 
large extent is lost, the power of walking is impaired, and 
the ability to write is destroyed. The symptoms are pre- 
ceded by deliritim or by an epileptiform convulsion, after 
which it is noticed that the speech is dcfcctiva Notwith- 
standing the fact that under other circumstances these 
symptoms uauaJly betolccn a serious affection of the nervous 
system, the patient will, if the illness is due to lead, in most 
instances recover. It is this tendency of saturnine pseudo- 
general paralysis to undergo amelioration which differentiates 
it from the classic malady. All cases, however, do not 
recover. When death has taken place the appearances 
observed in the brain have been those of general paralysis, 
and on chemical examination of the brain traces of lead 
have been found therein. 

Lead poisoning occasionally simulates tafifs darsaiu or 
hcoMwlor ataxia. There is incoordination of the muscles, 
attended sometimes by loss, sometimes by exaggeration, of 
the knee-jerk. Closure of the eyes so aggravates the muscular 
incoordination that the patient can hardly stand. In other 
instances the gait resembles that of a high-stepping horse, 
owing to weakness of the extensor muscles of the feet 
Under proper treatment the patients usually recover. 




METALLIC POISONS, DUST, FUMES, ETC. 209 

Since tbc nervous symptoms in ptumbism arc widespread 
and varied, there has been considerftble discussion as to 
whether the lesions are in the peripheral nerves and ^ve 
rise to a neuritis or whether they arc ditc to changes in the 
brain and spinal cord. On microscopical examination of the 
peripheral nerves in chronic lead paralysis there Is observed 
a markcci increase of the interstitial tissue, with atrophy of 
the nerve fibres, but the large cells in the anterior cornua of 
the spinal cord do not always escape. Although nerve cells 
are more easily affected by poisons than arc nerve fibres, 
the latter, owing to their distance from the centres of 
nutrition in the spinal cord, may exhibit greater sbruetural 
changes. The lesions in the peripheral nerves are due to 
changes in the cells of the spinal curd as well as to changes 
in the nerves. Gombault and Charcot consider that lead palsy 
is a peripher.il neuriti* only, and due to a segmentary and 
periaxial degeneration of the nerves, in this form of degene- 
ration the axis cylinder of the nerve fibre is spared : the 
structural alteration i« confined to a few of the segments of 
Ranvicr, while tlie nerve fibres above and below the aflfectcd 
parts are healthy ; hence the recovery of power which takes 
place in these case.*:. Occasionally in periaxial neuritis the 
axis cylinder undergoes fragmentation. Dfs. L.aslett and 
Warrington, of the Liverpool University Pathological 
Laboratories, have published the results of the micro- 
scopical examination of the nerves and muscles of the 
hands of a house-painter who had long suffered from 
wrist-drop. There was found marked atrophy of the pos- 
terior interosseous and ulnar nerves and a similar condition 
of the anterior roots of the sixth, seventh, and eighth 
spinal nerves, with a normal condition of the correspond- 
ing posterior roots. Ninety per cent of the muscle fibres 
of the extensor muscles of the hand were atrophied, but 
still retained their cross striation ; the connective tissue 
was increased, but the muscle spindles were unaltered. In 
the anterior comual cells of the sixth and seventh segments 
of the spinal cord there were evidences of chromatolyais with 
exccntral situation of the nuc1eu». While admitting that 
lead acts primarily upon the central nervous system, Laslctt 



3TO 



DISEASES OF OCCUPATION 



and Warrington arc of the opinion that in their patient tbi 
spinal con) lesion was ficcondary to the peripheral neuriti 
and they base Iheir opinion upon the cxccntral position of the 
nucleus. Adopting this view, the changes in the anterior 
comual cells would not be the result of the action of lead 
upon the spinal cord, but would be consequent upon a lesion 
of the axis cylinders of the peripheral ner\-es ; in other words, 
would be the result of a "reaction ^ distance," for a descrip- 
tion of which we arc indebted to Marincsca 

Asylum records show that lead poisoning may be a cause 
of insanity. Usually there are some premonitory symptoms, 
such as headache and toxic hysteria, or the patient appears 
as if he were intoxicated with alcohol Sometimes symptoms 
of acute mania develop suddenly. The delirium is of a noisy 
character and the patient is with difficulty restrained. There 
may be intervals of quietude in which consciousness is fuUy 
restored. Delirium followed by coma and attended by a 
rising temperature marks a serious condition, from which the 
patient rarely, if ever, recovers. 

There are many minor affections that lead gives rise to, 
<,f., swollen and painful joints, painful swellings on tendons, 
enlar|;ement of the submaxillary glands and testicles. The 
association of lead poisoning and gout has for many years 
l>een known, especially in the South of England. In tbe 
North we seldom find it. 

When quite unexpectedly the death of a lead worker 
has taken place, no symptoms of plumbism, or next to none, 
having shown themselves during life, there may be found 
few, if any, nakcd-cyc pathological lesions at the post-mortem 
examination of the body which will enable a physician to 
say that death has been the result of lead poisoning. Tbe 
presence of a blue line on the gums should always be looked 
for ; if found, it is confirmatory evidence. In acute saturnine 
encephalopathy the brain is sometimes shrunken and firm ; 
the brain substance may be pale and firm or pale and 
^edematous as in uraemia. If tlicre has been colic the 
small intestine may be contracted at places Dark blue 
patches should be looked for on the mucous membrane of 
tbe large and lower part of the small intestine. In acute 



4 




METALLIC POISONS, DUST, FUMES, ETC. 211 

tjjiumbism the kidneys may be normal in size and on 
microscopical examination exhibit signs of tubular nephritis: 
in chronic plumbi-im. on the other hand, the kidneys are 
small and contracted, the capsule is firmly adherent, and on 
microscopical examination there arc evidences of interstitial 
nephritts. To the naked eye the lunjjs, heart, liver, ar>d spleen 
in acute plumbism often present nothing unusual, so that 
it is extremely difficult to say, in the absence of a history of 
the case, and of knowledge of the occupation of the deceased, 
a chemical examination of the brain and liver, and of any 
urine that may be present in the bladder, whether lead 
poisoning was or was not the cause of death. In old 
standing cases of plumbism the contracted kidneys, 

^diseased arteries — rupture of which in the brain induces 
apoplexy — and the general malnutrition and pallor, all point 
to lead as the cause of the structural changes in the body ; 
but since alcohol, other poisons, and other conditions induce 
similar pathological results, the post-mortem findings alone 

Lean, in the absence of a history of exposure, only suggest the 

I probability of lead as the cause of death. On a chemical 

examination of the liver and brain being made, lead will 

}robably be found in these organs if the case is one of 

fplumbism. In the brain of one of my |>atients Professor 
fiedson found 0*634 grain of lead and O'Sig grain in the 
; in another female patient he found 0-779 grain of 
in the brain and 1 grain in the liver. One of the 
worst cases of acute lead encephalopathy that I have seen 

jwas with Dr. Inglis, of Hebburn-on-Tync. in the person of a 
>ung woman patient who had been quite healthy and had 
only worked thirteen weeks in a white lead factory when she 
had convulsions, in which she died. In her brain no lead 
was found. Lead in some instances must enter into chemical 
combinations with the substance of the brain ; lead-saturated 
cerebral cells would be incapable of performing normal 
function, but since death can occur without the slightest trace 
of lead being found in the brain after death, it would appear 

I as if death under these circumstances was the result of a 
primary action of lead upon the eliminating organs, such as 
the liver and kidneys, causing destruction or diminution of 



2tS 



DISEASES OF OCCUPATION 



their function and a secondary toxxmta in consequence. 
Once lead is introduced into the human body the excretory 
organs do their best to immediately eliminate it If minute 
quantities of lead arc administered in food to animals, traces 
of lead will be found in the urine a day or two afterwards. 
It is when the eliminating organs fail to throw the poison 
freely out of the system that retention occurs and symptoms 
of ill-health show themselves. The lead passes out of the 
blood into the tissues, with which it may form insoluble 
organic compounds and lie dormant for a long time, years 
it may be, or the compounds are redissolved, so that in 
the absence of renewed exposure to the [KMSon the patient 
becomes, ali intra, the subject of plumbism, and will probably 
be found passing lead in his urine. 

The treatment of lead poisoning is preventive and curative. 
So far as the prevention of industrial lead poisoning is con- 
cerned, allusion has been made here and there in IhcdC pages 
to several of the means to be adopted. The Regulations 
issued by the Home Office for all kinil.t of lead factories are 
a great advance upon those of former years, and if loyally 
carried out wilt do much to reduce industrial plumbism. 
Work in the potteries is still being carried on under the 
Amended Rules published after the arbitration meeting at 
Stoke previously alluded to. There must be, however, no 
standing still as regards the Home Office and its supcr%-ision 
of the lead industries. Experience has frequently demon- 
strated that an increase in the number of cases of lead 
poisoning has been the result of carelessness on the part of 
the worker* and non-observance of niles, laxity on the part 
of employers and foremen, and incomplete medical inspection. 
To fight successfully such an insidious foe as industrial lead 
poisoning Uicre must be constant watchfulness by all con- 
cerned, also frequent revision and extension of Home Office 
Rules and Regulations. 

Curative treatment concerns the individual. If the colic is 
not severe, rest in bed. application of external warmth, and 
the administration of a mild purgative, such as castor oil 
or magnesium sulphate, may be sufficient. Should the pain 
be accompanied by vomiting, draughts of warm alkidine water. 




METALLIC f^lSONS, DUST, FUMES, ETC. 213 



the administration of an effeirescing soda and bismuth 
mixture, and washing out of the large bowel by mcanH of an 
enema of warm water and olive oil, may be tried. When the 
pain in the abdomen is severe, relief may be obtained by a 
warm bath. To some patients it may be necessary to give a 
hypodermic injection of morphia, or of morphia and atropine 
combiiKd. A mixture of magnesium sulphate and potassium 
iodide answers remarkably well, but in the treatment of some 
cases of plumbtsm the administration of potassium iodide 
must be made with care, since, as Mclscns showed and my 
own experience confirms, the iodide may redissolve lead that 
has been lying inert in the body, cause its reabsorption into 
the blood, and thereby induce fresh symptoms of poisoning. 
Iodide of potassium is one of the best eliminants of lead. Jn 
cases where the symptoms have subsided but health has not 
been regained, the administration of the potassium salt will be 
followed by a reappearance of lead in the urine. I have known 
it cause albuminuria in chronic plumbism, which ceased with 
stoppage of administration of the drug. In cases where pain 
continues to linger in the abdomen and there is tenderness 
on pressure, I have found monosulphite of soda give great 
relief. Mild but lingering abdominal pain and paralysis 
quickly disappear under the administration of one-third to 
half a grain given every two hours. It is desirable in all 
circumstances to get the bowels moved. In due course, under 
the iodide and magnesium treatment, combined or not with 
Tinct. belladonna and carminatives, tlie .symptoms of saturnine 
poisoning will subside, and perhaps no lead be found in the 
urine. Altho»igh free from lead, if the urine contains albumen 
and the phosphates are markedly diminished, it i» more than 
likely that lead is still lying dormant in the tissues, for on 
administering iodide of potassium months afterwards lead 
may again reappear in the urine, the albumen may diminish 
or disappear, and the phosphates become increased. It is 
to this retention of lead in the tissues of the body and 
its redissolution and absorption that the development of 
fresh symptoms of lead poisoning must be attributed when 
occurring months after an apparent cure had been c^ifected. 
In chronic cascsof plumbism, where the kidneys arc aflected 



«4 



DISEASES OF OCCUPATION 



and the patient looks aged and his features altered, it Is rn 
Always wts« to give potassium iodide, but in recent cases of 
wrist-drop in young subjects the drug ought to be given 
combined with nux vomica and the administration of a saline 
in the morning. For paralysis, rest of the affected arm in 
splints with the daily application of mass^e and electricity 
will be found helpful. The constant current acts equally as 
well as the interrupted. Muscles which exhibit the reaction of 
degeneration, iV., which contract only to the direct application 
of the constant current, can be benefited by a course of 
induction coil currents. It is not a necessary reriuircmenl 
of electrical treatment that the responsive muscular contrac- 
tions should be strong. There is the risk in over-stimulating 
weakened muscles of inducing fatigue. Dr. H. I^wis Jones, 
of St Bartholomeiv's Hospital, recommends the electrical 
bath with the constant current in cases where it is sought to 
favour the electrolytic extraction of lead from the tissues. 
On the other hand, where electrical stimulation of the paralysed 
muscles is alone required, induction coil currents with or 
without a water bath arc called for. The two methods differ 
in degree rather than in essence. The extraction of lead 
from the human body by means of electricity and the 
deposit of the metal in the form of chloride upon the clcclro- 
lytc surrounding the body is more than a probable occurrence, 
and yet experimental evidence upon this point is not 
altogether free from error. Treatment of lead paralysis by 
electricity is both safe and useful. The use of the arm bath 
with the application of the sinusoidal current is very helpful 
in cases of wrist-drop. For more extensive lead paralysis, 
where, for example, the mu.scles of the legs are also affected 
a fulI-IaiKth bath with the use of direct and sinusoidal 
currents on alternate days is recommended by Dr. H. Lewis 
Jones as likely to " secure electrolytic effects as well as those 
of simple stimulation." Warm baths alone do good. For 
patients who are well off a visit to Bath, along with use of the 
thermal waters and electricity when there, is well worthy of a 
trial. Paralysis caused by lead is often slow to disappear, 
and for a time considerable muscular weakness is left behind, 
but in many cases the cure is quite complete. 



4 
4 



4 



' 

^ 




METALLIC POISONS, DUST. FUMES, ETC. 215 

It will fall to the lot of few medical men to treat cases of 
saturnine encephalopathy. During the convulsions the in* 
halation of a few draps of nitrite of amyl is of service. When 
the secretion of urine is scanty a hypodermic injection of 
pilocarpine is called for. Puncture of the lumbar region of 
the spinal canal and the withdrawal of one, two, or three 
ounces of clear fluid Hke water often reIie^'e'! the cerebral 
pressure. Or. Mosny, of the Hfipital St. Antoinc, Parb, makes 
use of lumbar puncture not only as a curative measure, but 
also for diagnostic purposes. On centrifuging the clear fluid 
removed from the spinal canal by puncture between the 
second and third lumbar vcrtcbrw, Dr. Mosny finds in it an 
excess of leucocytes, which he attributes to a reaction on 
the part of the cerebro-spinal membranes to the lead. In 
cases of acute lead colic in which I have punctured the 
spinal canal and drawn off one to two ounces of clear liquid 
like water, no trace of lead was found on submitting to 
chemical analysis the three or four samples, drawn from 
different patients. 



tAPTER VIII 

DISEASES DUE TO METALLIC POISONS, DUST. FUMES, ETC 
(CONTINUED) 

OriiRft Forms ok Mktallic I'otMMiNa 



Arstttie 

ARSENIC is used in the arts and manufacturers. Until 
recently it wax extensively use<l as a colouring agent 
for wallpaper;; and artilicja) flowcr^i. It is an ingredient 
of the "sheep dip" which is sold to kill tic in sheep. 
Workers In arsenic sutTtrr from jwinfu! redness of the eyes 
and from eczema of the eyelids. More than a quarter 
of a cenluiy ago the Medical Society of Ijondon reported 
upon the unhcahhincss of the trades in which arsenic was 
used. In the form of green arscnite of copper or Schcelc's 
green it is used as a pigment. It is in this form, too, that it 
was added to wallpapers, in which it was often present to the 
extent of several grains per square yard, and as it is readily 
given off in the form of very fine dust, its presence in the air 
of a sleeping-room can be readily understood, and the ill- 
health of persons occupying these rooms just as readily 
explained. The symptoms complained of by persons 
occupying such rooms arc headache, dryness of the throat, 
loss of appetite, mental irritability, depression, and loss of 
flesh. Men employed in the manufacture of Schcele's 
green have frequently painful ulcers on their fingers or on 
such concealed parts of the body as the groin and scrotum, 
where the dust has collected. Arsenic acts as an irritant to 
the stein, setting up eczema and ulceration : it is capable of 



producinfj general poisoning as vrcM. Five or six years ago 
then: occurred in the MidiandK an outbreak of arsenical 
poisoning, the result of drinking beer made from glucose 
which contained arsenic. Much suffering and ill-health 
followed Many of the patients suffered from a painful 
affection of their limbs, neuritis followed by paralysis, dropsy 
of the limbs, and ulceration of the slcin. Arsenical neuritis 
mainly aflccts the lower extremities, and in that respect 
differs from the paralysis caused by lead, which is mostly 
of the hands and fingers, 

In visitinjT colour works I have seen ulcers on the hands 
of the workmen, but in the manufacture of white arsenic 
I have not noticed any serious ill-health among the employed, 
White arsenic is made in closed chambers. The only risk 
occurs during the packing of the finished product. The ill- 
health of the men employed at the reduction works of the 
arsenic mines near Tavistock, Cornwall, attracted a few years 
ago the attention of the Home Office, und was made the 
subject of an itiquir>' and a Report by Mr. Edward Gould, of 
the Home Office, and Mr. Joseph S. Martin, H.M. Inspector 
of Mines. Several of the smelters suffered from " arsenic 
pock," an irritation of the skin due to the action of very fine 
dust upon the perspiring skin ; others suffered from bronchitis 
and respiratory troubles to a greater extent than the workmen 
engaged in other trades in the district. In the manufacture 
of the refined arsenic of commerce, the arsenic ore, or " mis- 
pickel," is first crushed between rollers, then sieved, and 
calcined in flat furnaces. The arsenic thus liberated from 
the ore passes from the funiaces to flues and chambers. 
These are cleared out and the arsenic soot, so called Because 
it contains coal dust, is collected. This is again submitted 
to heat in a refming furnace, only anthracite coal and coke 
being used. The fumes given off settle as a 6ne white 
powder, which becomes, when ground, tile white arsenic of 
commerce. 

In the emptying of the flues respirators ought to be worn 
by the men, and no flue should be entere<l by the workmen 
until the temperature has come down to that of the surround- 
ing media. The bronchitis which arsenic workers suffer from 




2l8 



DISEASES OF OCCUPATION 



has been attributed partly to the fumes given off by the 
material, which contains a good deal of sulphur. It Is also 
the rcsuU of exposure to rapid changes of temperature. 

Men when employed in removing vitriol solution from the 
depositing tanks in copper works occasionally suffer in con- 
sequence of the inhalation of arscniurettcd hydrogen gas. 
The symptoms met with arc dizziness and collapse, followed 
by jaundice and bleeding from the kidneys, attended by a 
rise of temperature. 

An important point in connection with the subject we are 
discussing is that arsenic, whether taken as medicine, inhaled 
as dust or vapour, or applied externally to the slcm, has 
apparently the effect, in some persons, of predisposing the 
tissues to growths of a cancerous nature. Workers in aniline 
colours wliich accidentally or otlierwise contain small quan- 
tities of arsenic frequently exhibit patches of brown dis- 
colouration on their skin and mucous membrane, paralysis of 
certain muscles, and digestive troubles. Du'cct contact of 
the skin of the workpeople with arsenical compounds is a 
fruitful source of trouble. No matter the channel by which i 
it gains entrance into the human body, arsenic is climinated^| 
into the stomach and intestine, and in passing through the " 
wall it induces marked Ityper;i:mia, with symptoms of irritant 
poisoning, in the gastro-intestinal tract. The hands of the 
workmen should be free from cracks and sores. Gloves 
ought to be worn. If a man must work with his naked 
hands, all fissures and sores on the skin ought to be covered 
over by surgical collodion. 

Arsenic is used in the curing of certain furs. Out offor^- 
two samples of furs recently examined by American chemists 
eleven were found to be heavily loaded with arsenic The 
destructive effects of arsenic upon insect life are well known. 
Presumably, therefore, the arsenic is added to the furs as a 
preser\'ative. The ajnount of arsenic found exceeded the 
one grain per square yard allowed by American law; it often 
reached 170 grains. The presence of such large quantities of| 
arsenic in furs that arc to be worn and in nigs for rooms is 
very dangerous. Occasionally it is found as a pigment in 
gloves and in textile materials. 



I 

I 

I 
i 

'4 

IS I 




METALLtC POrSONS, DUST, FUMES, ETC. 119 



CopptT 

Opinions are divided as to the harmful effects of copper 
upon the human body. That some of the workmen who arc 
exposed to the fumes of the molten metal and to the metallic 
dust suffer from deranged digestion and troubles of the 
nervous system is only what misht be expected ; but there 
is never anything like the severe attacks of abdominal pain 
which arc met with, for example, in lead smelters. I have 
known working shoemakers who were in the hnbit of putting 
brass nails in their mouth suffer a good deal from colic. A 
few ct^per workers have come under my care complaining 
of nervous depression, dizniness. and a staggering gait when 
walking. Metallic copper \% less injurious than some of 
its compounds and alloys, such as brass. Symptoms of 
irritant intestinal derangement occasionally follow the ingea* 
tion of food cooked in copper utensils. In copper workers 
there can be frequently seen a grccnish-bluc line on the 
teeth, and the hair of the older workmen, which otherwise 
ViTouId be white, is quite green. Yet by none of these men 
is there complaint of feeling ill. On examining the hair 
under the inicroscn|ie a thin layer of coloured material can 
be seen, composed of bUiish-grccn crystals. These develop 
a deep blue colour on the addition of ammonia. By washing 
the hair in warm water the crystals are dissolved and the 
hair again resumes its normal colour, while in the water used 
for washing copper is found. 

Although in copper ore, or what is known as copper 
pyrites, there is often a trace of arsenic, it is astonishing how 
free from sympt(}m3 are the copper smelters. 1 have visited 
the lai^c copper-mines and smelting works at Kopperberg, 
in Sweden, and although the whole atmosphere recks with 
the sulphur fumes given off during tlie roasting of the ore 
and the spire of the cimrch and the roofs of the houses are 
coloured grccnish-bluc by the copper, yet the workjxixjple 
seemed to suffer no greater inconvenience than, and were just 
as healthy as. persons foIlowinK other occupations elsewhere. 
What has been said of Koppcrbcrg also applies to the smelt* 
[ng works at Swansea ; although the v^etation in the 



2M 



DISEASES OF OCCUPATION 



nelgfabourtiood has been destroyed, the men who work at 
furnaces enjoy good health. They arc exposed to great 
cluuiges of teraperatuie, and are not always careful in regard 
to the use of alcoholic stimulants. In the cleaning out of 
the flues a great deal of dust is met with, and if the dust has 
not been previously watered there is apt to be illness among 
the men. 

Brass 

Brass is an alloy of rmc and copper. Birmingham is 
home of this particular trade. During the pouring of the 
molten alloy into moulds the workroom becomes filled with 
dense white smoke, composed largely of oxide of zinc. The 
smoke, after hanging in the atmosphere for a time, ultimately 
settles down upon the rafters and ceilings of the workroom 
as a white incrustation. During foggy weather the atmo- 
sphere in these workshops is thick, and as many of thc5c places 
are badly ventilated the men frequently suffer from head* 
ache, dryness of the throat, and a sense of general malaise. 
Digestive troubles, too. are often complained of, but the 
special malady from which these men suffer is what is called 
" brass-founders' ague," a misnomer, since it has no connec- 
tion whatever with malarial fc\*er, yet an illness attended by 
shivering, usually by feverishness and sweating, and accom* 
panicd by a feeling of exhaustion. Before the temperature 
rise-i, or in what corresponds to the cold stage, there is con- 
siderable languor, accompanied by a feeling of depression ; the 
teeth chatter, and. as in the classical form of ague, there arc 
headache and nausea. Occa-sionally the patient vomits, and 
obtains relief thereby. The indisposition, which usuaJly lasts 
from one to two days, usually attacks men beginning work for 
the first time or who have been absent from it for a period. ^ 
Owing to the dusty nature of the occupation, bronchitis and ^| 
pulmonary phthisis are not unknown among the men. It is ^ 
maintained, too, by some physicians that brass workers are 
more liable to affections of the nervous system than other 
workmen. The symptoms complained of by brass workers 
whom I have seen at the Newcastle Infirmary have been mostly 
on the side of the digestive organs, such as loss of appetite 



4 
4 




METALLIC POISONS, DUST, FUMES, ETC. 221 

distaste for food, a luetaUic taste in the aiouth. obscure abdom- 
inal pains, constipation or diarrhora, a sense of thirst and 
of dryness in the throat, without any visible sii^ns of pharyn* 
gitis, also a de^n'ee of mental depression often amounting to 
hypochondriasis, and difBcult to remove by medicinal treat- 
ment The men become extremely nervous. When protruded 
the tongue is observed tu be the scat of fibrillary tremor, and 
there is similar trcmulousncss of the muscles of the checks. 
It is difficult to say which of the two metals, zinc or copper, 
is the cause of " brass-founders' ague." The late Dr. Green- 
how attributed the symptoms to the sine. Dr. Hogbcn puts 
them down to the copper. It b more than probable that the 
symptoms are due to an admixture of the metals. 

The ncccbsity of personal cleanliness on the part of the 
workmen and of well ventilated workshops is apparent. 
Means ought to be provided for a ready escape of the fumes 
and for the removal of dust. The workshops ought to be 
cleaned at least once a year and the walls whitewashed. 
Mot and cold water should be provided for the men to wash 
In. The workmen themselves have found out by experience 
that milk is both a prophylactic or preventive as well as a 
curative agent White the use of respirators seems called 
for, the men cannot work well in them. Women and persons 
under eighteen years of age arc not allowed to work in the 
casting shop, 

Zine 

It used to be thought that the fumes given off from 
pure zinc were not dangerous, but in the smelting of rude 
zinc ores which contain f6 per cent of lead there is a 
certain amount of danger from plumbism, and in the 
similar treatment of bUndt, which is a sulphide of zinc 
and arsenic, the smelters occasionally suffer from the effects 
of arsenic Dr, John Tatham's figures show that zinc 
workers have a higher mortality than the average work- 
men, viz., 1,19s, as against 602 for the agriculturist, and 
that the death-rate in zinc workers has rather risen within 
the last dcccnnium. The workmen arc exposed to great 
heat In men beyond the middle term of life the 



222 



DISEASES OF OCCUPATION 



ntortality from pulmonary phthisis and respiratory diseases 
generally is more than double the standard 6gure. In my 
visits to the large zinc smelting works at Blciberg, in 
Belgium. 1 could not find any evidence of ill-health among 
the workmen traceable to the zinc itself. Respiratory 
aflfcctions were common, owing to chilling of the body 
when in a state of perspiration, and rheumatic affections 
of the muscles and joints were also complained of. The 
dust from the furnaces is stated to be the cause of boils 
on the skin and of eczema, but these arc met with in 
most industries in which the men arc exposed to great 
heat and perspire frccl/ in an atmosphere containing fumes. 
Schlockow, who has had large experience of the zinc 
miners and smelters of Silesia, states {Deutsch. Mid. 
Wochen., 1897, vol. v. p. 208) that tn men who have 
foUoivcd the occupation for ten or twelve years there are 
frequently observed diseases of the nervous system. There 
is a loss of the sense of touch in the limbs, accompanied 
by burning sensations in the soles of the feet ; the knee- 
jerks are exaggerated, the muscular sense is diminished 
and walking becomes unsteady, symptoms which Schlockow 
attributes to a lesion of the anterior columns of the 
spinal cord, but which other writers regard as due to a 
polyneuritis the result of lead poisoning. In Silesia the 
workmen suffer from laryngeal and bronchial catarrh as 
the result of dust, but tuboculosis is rare. 



^ 



Zifu IVAt'te or Ziiu Oxide 

Since zinc white has come to be regarded as a substitute] 
for white lead for house painting, especially in France, there 
arc sure tn be In the future greater demands for this material. 
Zinc white is obtained by the oxidation of zinc vapours, the 
product being aftertt-ards washed and dried. During the 
drying, sifting, and packing of the finished product dost b 
given off, but with ordinary care, such as good ventilation 
and the filling of the barrels in enclosed spaces provided 
with fans, the men employed do not appear to suffer any 
inconvenience beyond slight headache now and then. 1 did 



METALLIC POISONS, DtJST, FUMES, ETC. 223 

not find that animals exposed to oxide of zinc in the fonn 
of dust, or who received it in their food over a length of 
tfaie, showwi signs of poiftoning. but other writers stale that 
dogs succumbed to albuminuria and glycosuria after having 
showii signs of nausea and disinclination for food, attended 
by anannia and a distinct leucocj'tosis. 

Men employed in printing upon zinc by means of chromic 
and phosphoric acids incur certain risks. These acids arc 
applicicl by means of a sponge to cliche of zinc in order 
to remove all traces of fat so as to give more relief to the 
drawing. Phosphoric acid when employed alone causes no 
trouble, but it i^ not the same with chromic acid. This acid 
is a frequent source of abscesses and of erosions of the skin of 
the hands, arms, face, and neck. Some men are so susceptible 
to the action of chromic acid that they arc obliged at an early 
date to give up the work. In one workshop onc-siKth of 
the men had been off ill with abscesses, from which in some 
instances it took the men a fortnight to recover. India- 
rubber gloves have been recommended, but since experience 
has shown that the employment of these acids is not absolutely 
indispensable, and that a mixture containing only one of the 
acids in very small quantity gives equally good results and is 
free from danger, it would be better to adopt the newer 
method of printing than to rely upon gloves, the wearing of 
which can only protect the bands and forearms. 



Affrcury 

Mercury, or quicksilver, is found in large quantities in 
Spain and California. It exists in nature in the form of 
cinnabar, a sulphide of mercury, from which it is obtained by 
simply roasting the ore. either alone or by mixing it with 
lime or iron filings. Mercury in the metallic form is thus 
given off and readily condenses. Workmen employed tn the 
extraction of the metal fnxiuently suffer from the mercurial 
vapour, which, quickly condensing, forms droplets tliat become 
deposited upon accessible mucous membranes and upon the 
beard and hair of the men. The metal rapidly becomes 
oxidised, and a thus rendered easy of absorption. Hen 



2X4 



DISEASES OF OCCUPATION 



also become poisoned by handling the metal, for the skin ! 
becomes creased, and in the depths of the creases line particles 
of the oxide of mercury become deposited, Mercury may be 
inhaled as vapour or as dust in the form of metallic salts. 
Men with open sores on their body ought not to be 
allowed to work in mercury. Formerly the metal was 
largely used in the silvering of mirrors. It was then a 
proline source of ill-health among the workmen, but since 
the introduction of the new method of applying a solution i 
of argentic nitrate to the glass and precipitating the silver by 
means of tartaric acid, the silvering of mirrors has ceased to 
be the unhealthy occupation it was in days gone by. 

Mercury is used in the construction of barometers,' 
thermometers, and instruments of scientific precision, 
while its salts, especially the nitrate, are used in felt hatj 
making and fur dressing. One of the commonest symp- 
toms of mercurial poisoning is ulceration of the gums 
attended by fetid breath and excessive salivation. Follow- 
ing closely upon these come mu.scular tremor and 
cachexia. In the process known as "carotting" or the 
brushing of rabbit skins with an acid solution of nitrate 
of mercury, the workmen lose the molar teeth of the 
upper and lower jaws. The remaining teeth become 
black and loose Where the teeth have not fallen out 
they become eroded, owing to the action of the acid 
vapours. 

The muscular tremor exhibited by workers in mercury 
has long been known as a symptom of poisoning. Years 
ago the amount of ill-health in the mercury miners ati 
Almaden in Spain was so great that the mines had tr 
be worked by convicts. These men not only worked 
but also lived, in the mines. They were noi all cleanly j 
in their habits, and as a consequence the mortality from 
mercurial poisoning was high. The few free men who 
were employed at the mines worked intermittently. In 
the intervals they followed agriculture or worked in their 
gardens. As these men were more cleanly in their 
habits tbey escaped much of the sickness, and on the 
whole had good health. 



i 




METALLIC POISONS, DUST, FUMES, ETC. 225 



Although mercury is no longer employed in the silver- 
ing of mirrors it is still used in the arts and manufactures 
to such an extent as to be a source of considerable 
trouble and ill-health. It is Krcatly in demand for the 
sepajation of gold and silver from their respective ores 
by means of an amalgam ; in sole stitching by Amcricaji 
machinery ; in the manufacture of incandescent lamps, in 
which mercurial putnps are used so as to create a 
vacuum ; in water-gilding, where an amalgam of gold or 
silver, after having been applied to an object, is heated 
and the mercury driven off by heat, also iti bronung the 
interior of Beld-glasscs. 

In the extraction of gold from its ore mercury plays 
an important part When the crushed auriferous soil has 
been subjected to several wa&hings there remains a fine 
siliceous powder in which the gold Is occasionally present 
in very small quantity, and in the form of too fine 
particles to be isolated by mechanical means. An 
attempt is therefore made to dissolve the gold in 
mercury until a rich amalgam is formed, from which the 
gold is separated by raising the temperature to 400^ C. 
During the process, which aims also at the recovery of 
the mercury by condensation, the mercurial vapour escapes 
through the joints of the apparatus into the atmosphere, 
and as a consequence the worl<men occasionally su^er in 
health. Metallurgists now Bnd that in cyanide of potas- 
sium they have a good substitute for mercury, one that 
acts more easily and is attended by less risk to health 
than mercury. The cyanide process of dealing with 
gold ores has quite revolutionised tlie industry, and has 
made retf mining, which until lately was regarded as 
altogether a secondary source of gold, more important 
than aliuvial and placer mining. It is an illustration of 
what can be done by the application of science to an industry 
that called for all the resources of chemistry. ( Vid< p. 236.) 

Mercury volatilises at a low temperature. It is this 
circumsunce which creates the danger, and explains the 
risks run by men working in a heated atmosphere containing 
the vapour given off by the metal. Many of the men 



2i6 



DISEASES OF OCCUPATION 



become pale and ccwnptain of headache and giddiness. TTic 
muscles of the face become tremulous ; so, too, do those oTthe 
tongue, also the muscles of the limbs, especially those of the 
arms. The breath becomes fetid, the gums soft, swollen, and 
ulcerated, and the teeth loose. The face becomes pale and 
cachectic, the submaxillary and other glands in the neck be- 
come painful, and the secretion of saliva 6x00551%^. Speech 
is slow and indistinct, owing to involvement of the muscles 
of articulation ; the patients lose their power of n-alking and 
become depressed and melancholy. Females suffer from 
suspended menstruation and pregnant women often mi^arry. 
Many of the workers succumb to phthisis and to kidney 
disease. Others become the subjects of convulsions or are 
seized with paralysi-s, or they develop symptoms not unlike 
those obser\'ed in general paralysis, but without the inequality 
of pupils and the grandiose ideas characteristic of the 
more classic affection. The children of workers in mercury 
are often ill-nourished and rickety, and statistics show that 
they die from pulmonary phthisis in larger proportions than 
the children of persons employed in other occupations. 

Cases of industrial mercurial poisoning occurring in the 
practice of medical men must be reported to the Chief 
Inspector of Factories at the Home Office. So far as the 
workpeople are concerned, scrupulous attention must be paid 
to details : personal cleanliness with frequent ablutions is a 
necessity, the hair and beard should be kept short, overalls 
should be worn when at work and astringent mouth-vrashes 
used — ^^..ahirn, to which, when the gums arc sore, potassium 
chlorate should be added — respirators should be worn, the 
sponge in which should be dusted nn'th sulphur, workrooms 
should be well ventilated, and there ought to be periodical 
medical examination of the persons employed. In factories 
where several different processes of manufacture are carried on, 
those connected with mercury should be relegated to separate 
rooms, in which the temperature ought never to be high, owing 
to the ready volatilisation of the mercury. 



METALLIC POISONS, DUST, FUMES, ETC. 227 

Manganest 
Dr. von Jaksch, of Prague, has drawn attention to chronic 
poisoning in manganese workers. Three of his patients, all 
men, in the early stage of the illness exhibited an uncon- 
trollable desire to laugh and to weep, such as is obser\'ed 
in hysteria, but as these passed away, symptoms indicating a 
deeper implication of the nervous system showed themselves. 
A year afterwards the men could not walk properly : they 
exhibited the peculiar staggering gait met with in locomotor 
ataxy. Embden, another medical practitioner, has described 
similar symptoms in four manganese workers. In still 
another of Von Jaksch's patients there were signs of mental 
derangement as welt as incoordination in walking. The 
poisoning is attributed to the inhalation of oxides of man- 
ganese. Experiments upon animals have not given con- 
firmatoty results, but as in Von Jaksch's and Embdcn's 
patients it took four years' exposure to develop symptom^ 
the time spent in experiments was probably too short. In 
manganese works means should be provided for removal of 
dust and the ventilation should be ample. 

Iron and Steel 
Iron ore b seldom found In nature in .<Hich a state of purity 
as not to be required to undei^o some such preparation as 
roasting in order to get rid of foreign material. This is 
carried on in lar^c furnaces, into which iron and coke, with 
or without other .substances, are placed. Atmospheric air is 
driven into the furnaces under high pressure. TTie tempera- 
ture is raised extremely high, so as to allow of fusion of tlic 
metal taking place, after which it is run off in a molten form 
into pits of sand, the result being bars of pig-iron. In 
another portion of this book attention is directed to the acci- 
dental poisoning by carbon monoxide of the men who 
charge the furnaces and who superintend the tapping pro- 
cesses. The work of the blast- furnaccman is hard: he is 
exposed to rapid and great changes of temperature, and as a 
consequence runs the risk of becoming chilled and of suffer- 
ing from bronchitis and rheumatism. He frequently gets 
burned, and on a windy day is often blinded by the sand of 



338 



DISEASES OF OCCUPATION 



the pit. As a class, blast-fumaccmcn arc apt to be in- 
temperate in the use of alcobol. Owing to the arduous and 
exposed nature of their employment they age quickly. 

In order to produce finished iron, the pig bars are heated 
in a furnace, where they undergo the process of "puddling." 
The work of a puddlcr is extremely hard. It consists in the 
impure iron being rolled about in the furnace by means of 
two long iron tools, called " paddle " and " rabble," so as to 
get rid of the carbon. The iron thus treated forms a large 
round bill. In this form it is removed from the furnace. 
Apart from exposure to the excessive heat, the work entails 
upon the men considerable muscular exertion. They per- 
spire freely and drink correspondingly. Many puddlers are 
prematurely old. In consequenceofthe severe muscular strain. 
heart disease, especially disease of the aorta and its valves, is 
common in these men. Puddling is justly regarded as one of 
the most injurious occupations in an ironworks. In conse- 
quence of steel having replaced iron in shipbuilding and 
other industries, the demand for finished iron is bcccMning 
less and le$s, and as a result puddling is a decaying trade. 

In consequence of their hard work blast- furnacemen and 
puddlers arc liable to fatigue and to burns and other 
accidents. The labourers who remove the large pieces of 
slag to the tip-heap arc occasionally injured by the mass ex- 
ploding, owing to the vibration caused by the transport or 
the tension of the gases enclosed within the outer coating of 
the sl^. 

In iron and slcel foundries finished steel in a molten state 
is jioured into moulds. The risks incurred by the men thus 
employed are mostly the results of injuries and the effects 
of dust. If the moulds are not sufficiently dry — and this 
remark applies particularly to the large moulds in the pit of 
Bessemer steel works — explosions may occtirand be attended 
by fatalities. In this country there are few statistics relating 
to tlK maladies and deaths of men employed in ironworks, 
but in Germany st;itistics show that the deaths are mostly 
from diseases of the respiratory organs, of which pulmonary 
phthisis forms 35 to 41 per cent. The average age of moulders 
who die from tuberculous phthisis is 41*8. 



METALLIC POISONS, DUST, FUMES. ETC. azg 



Blacksmiths and forgcmcn may be dealt with here The 
work of hammermen is hard. In ihc North of England it is 
a frequent cause of hypertrophy of the heart and disease of 
the aortic valves. Much of the work previously done by 
hammermen is now done by machinery. When heavy hand 
stedge-hamm«rs were more in use than now, there was a form 
of paralysis of the muscles of the arm<i known as " hammer- 
men's paralysis." My surgical colleague at the Koyal 
Victoria InRrmary, Mr H. B. Angus, tells me that a great 

my forgcmcn still seek advice there on account of a 
'painful inflammation of the joints of the wrists and elbows. 
In regard to " strikers' arthritis " it is interesting to note that 
the affected joint docs not improve rapidly under treat- 
ment, even after all work is forbidden. Notwithstanding the 
apparent healthiness of the occupation a considerable propor- 
tion of the men die from lung diseases, including tuberculous 
affections. Heart disease, too, is common in the men. 

Although Longfellow in his poem has popularised the 
brau-nincss of the blacksmith's arm and on examination a 
marked degree of muscular hypertrophy is frequently found 
to exist, still in several instances I have been struck by the 
/eeble physique of many blacksmiths. The introduction of 
machinery has allowed a feebler class of men physically to 
enter the trade. Where the work is very hard and there is 
excessive use of the ann, rupture of muscular fibres of the 
upper arm and shoulder has been known to occur, followed by 
inability to use the arm. In consequence of the men stand- 
ing for many hours daily exposed to liijjh temperatures and 
subsequent chilling of the body, lumbago is a common 
complaint. Owing to similar causes I find kidney dis- 
ease frequent in men employed in iron-fitting workshops. 
Anemia, too, is often met with, due to excessive heat ; and in 
consequence of the carbon and iron dust blocking the pores 
of the skin, eczema and boils are not unknown. Ironworkers 
and boiler- makers, especially the latter, suffer from deafness 
wving to the great shocks to the ears from the loud noises of 
hammering. How the hammering catises the deafness of 
boiler-makers, which is as extreme as it is common, it b 
difficult to say. Probably there is considerable shock to the 



436 



DISEASES OF OCCUPATION 



liquid in tlw labyrinth of the ear, and lliere is induced a 
brus(]ue displiicemcnt of the terminal cndinRs of the auditory 
nerve : these are either paralysed or become the seat of some 
abnormal irritation, which is subsequently followed by loss of 
function. 

I'reventive measures consist in putting; on adequate cloth- 
ing after exposure to heat, so as to protect the body from 
chills. To prevent boiler-makers from becoming deaf the 
ears might be stopped with cotton wadding. 



Stetd Grinding and ths Poitskin^ of AftUUt by Filts and 
Emery- tv fuels 

For several decades Sheffield stccl-grinders have had an 
unenviable notoriety on account of their high mortality from 
pulmonary consumption, and when ive consider the nature of 
their employment this is readily understood. There are two 
kinds of steel -grinding, the •' dry " and the *' wet," and as the 
work is of a special character, only trained men can earn good 
wages, A period of apprenticeship has to be served. The 
grinding is done on circular stone wheels driven by steam or 
water-power. Many of these stonej* are obtained from 
quarries in the neighbourhood. Considerable care has to be 
exercised in their selection, for as they have to be run at great 
speed the slightest flaw in the stone may cause it to burst, 
and Ihe fragments, flung in all directions, may inflict seriousor 
fatal injuries on the men in the workshop. Previous to uaing 
the grindiog-stoncs they are raced, or run, so as to Bnd out 
whether any flaws are present. 

So far as the two methods of grinding cutlery are con- 
cerned, the dry method is, from a health point of view, the 
more dangerous to the workers. The dust is dry, and is in 
the form of a very fine powder, which readily reaches the 
lungs owing to the attitude of the men when at work. Steel- 
grinders »tt astride the gnnding-stone on a saddle, and as 
they lean forward, keeping close to their work, they cannot 
but inhale some of the dust, which is a mixture of steel and 
stone. Forks and needles arc generally ground by the dry 
method ; knives, scissors, and razors by the wet. Some arc 



METALLIC POISONS. DUST, FUMES. ETC. 231 

ground by both mclhods, e.g., the backs of razors and scissors 
arc ground by the dry method and the remainder of the blade 
by the wet. It was in 1S65 that Dr. T. C Hall of Sheffield, 
drew attention to the high death-rate of steel-grinders from 
pulmonary phthisis. The average age at death of steel' 
grinders wa!> at this period only twenty-nine years, but of 
late this has improved. Dr. Hall's statistics referred to dry 
grinding. In wet grinding the running stone passes through 
a thin layer of water in a trough below the stone, so that, as 
its surface is always kept wet, comparatively little dust is 
given off during the process of grinding ; but while the atmo- 
sphere b clearer of dust, the floors and walls of the workshop 
are damp and cold. The grinding is carried on in rooms 
called "hulls." which are bounded by three blank walls ; the 
windows are without glass. Where dry grinding is carried 
on there arc fans, but these often prove incRcctivc It is no 
uncommon thing to find men engaged in different pnacesses 
in one laige room, so that the dust which is generated aflecta 
not only the workman sitting at his own grindlng-stonc, but 
the other inmates of the room as well. In Sheffield it has 
been ascertained that in every i/xx> deaths among steel- 
grinders pulmonary phthisis is the cause of 345, and other 
respiratory diseases 395 ; that is, collectively, pulmonary 
diseases account for 64 per cent of the entire mortality, 
whereas among the adult population of the country generally 
phthisis accounts for 144 deaths per 1,000, and other respira- 
tory diseases 182, or collectively jfi"^ per cent. Steel-grinders 
die comparatively young. Dr. Sinclair White, in " Dangerous 
Trades," p. 414, says that 458 grinders in every 1,000 die 
between the ages of 35 and 55. compared with aiSi in every 
ijOOo of the entire male population of the country. Only 
140 grinders out of ever>* 1,000 reach the age of 55 and 
upwards, whereas for every 1,000 of the adult male popula- 
tion 391 reach 55 years and upwards. Sinclair White is of 
the opinion that phthisis Ls not so rife among stecl-grindcrs 
as formerly. In Dr. Hall's time the average age at death 
from phthisis was 29 years ; at present it is 43. 

What has been said of Sheffield is equally true of the 
dusty steel trades of the German town Solingen, of which a 



234 



DISEASES OF OCCUPATION 



hours except under a stream of water or unless the stone Is 
entirely enclosed in casing except at the working place of the 
raising tool. One of the features of Solingen is said to be the 
large number of " home workers." These workmen own their 
houses, behind which is a garden, and at the rear of this their 
small factory. There are 1 ,475 small factories of this type In 
the district. In these tliu greater part of the grinding and 
glaj-.ing of scissors and razors is done. The Doors arc kept 
clean and provision la made for the removal of the dust 
during (jrinding. Cutlery manufacture is recognised as a 
dangerous trade in Solingen, and In recent years considerable 
improvement has taken place in the means to prevent dust. 
With the clean and tidy appearance of the« tenement 
factories those of Sheflieid compare most unfavourably. In 
Solingen the grindstones and polishing- wheels are run 
towards the worker ; in Sheffield they arc run away from 
the worker, so that the dust has an upu-ard tendency and 
flics into the room. 

There is a branch of the steel and iron trade which may 
t>e causative of phthi-sis and to which not much attention 
has been paid medically. J refer to " metal dressing," which 
consists in chipping off the rouj^h surfaces and removing the 
incnistcd sand from castings, also of smoothing them down 
by means of chisel and hammer. The work is similar to that 
of the stonemason and is equally dusty. As several men 
may be employed in the workshop doing this particular 
work at the same time, the atmosphere frequently becomes 
extremely dusty. Inhalation of the dust may lead to 
pulmonary troubles, especially in men who have a history of 
phthisis in their family. The disease affects the base of the 
lung in the early stages. During tlie course of the malady 
1 have seen haimoptysis occur. 

Bronsing in Lithograpkte Works 

The gilding of show-cards, advertisements, and Christmas 
cards is effected by dry bronzing. Bronze powders are 01 
various colours — red, green, golden, silver, Stc. Ordinary 
bronze powder is composed of copper and xinc with 0*12 per 



i 





METALLIC POISONS, DUST, FUMES, ETC. 233 

bending down upon the stone when at work, it is easy to 
explain, in consequence: of the constrained position, the 
deformity of the chest wall that is occasionally observed in 
apprentices to the trade. 

As the hulls and grind ing-whecis in Sheffield usually 
belong to property owners, who let off the rooms, often singly, 
to men who again sublet the stalls to cutlers who arc piece- 
workers, and who contribute their share financially for the 
motor-power supplied, it has been difficult to determine the 
proper individual upon whom to fix the responsibility for the 
provision of fans for the removal of dust, belter ventilation, and 
the maintenance of the rooms in a clean and dry state. There 
are about wet grinding hulls a dampness and a stagnation of 
the atmosphere which rather predispose the workmen to pul- 
monary diseases. The wearing of respirators has been recom- 
mended, but the men say they 6nd it irksome to work in them, 
■rinding wheels ought to be provided with hoods connected 
^th fans, which would act only remove dust but would also 
improve ventilation. As already stated, no grinding-stone 
should be mounted until after careful examination of the 
stone by a competent person, and it should be " raced " or 
tested Rrst, both as to speed and endurance, at a time few 
workmen arc present in the room. Dry and wet grinding 
should be carried on in separate departments. 

An interesting compari.son is made between SoiinKcn and 
Sheffield by Mr. C. Johnston in the Annual Report of the 
Chief Inspector of Factories. 1906, [>. 106. The atmosphere 
of Solingen is bright and clear. It is seldom that black 
smoke is seen escaping from the factory chimneys. This is 
lately the result of careful tiring and the use of coal briquettes 
instead of ordinary coal, which entails the use of slack coal. 
The day's actual work is nine hours ; on Saturday work 
ceases at 5.30 p.m. The factories in Solingen are said to be 
marvels of order and cleanliness ; the floors are of concrete 
and the air-space for each worker is 565 cubic fecL A!! the 
grinding-stones arc protected by guards. The walls of the 
workroom.s are limewashed every year; the floors arc swept 
clean every evening and damp-wiped once a week. The 
"racing" of grindstones is nc\'cr undertaken during working 



DISEASES OF OCCUPATION 



After the wallpaper receives its "ground" colouring^ 
beiiig passed tbroueh troughs containing coloured liquid, it 
travels onwards through several machines to receive its 
pattern and diflerent colours. It may have to undergo 
"flocking," "bronzing." or the laying on of "mica" powder, 
all of which arc more or le&s dusty processes. The mica 
dust IS composed mostly of silicate of magnesia. 

The dangers of working are mainly those incidental to 
dusty occupations generally and to exposure to working En 
overheated rooms. Since the abolition of lead and arsenic 
as colouring agents wallpaper staining has ceased to be the 
unhealthy occupation it was a few years aga 

Personal c1canline» of the workmen and the use of baths, 
the wearing of respirators in dusty processes, the wearing of 
overalls and head-coverings, aLso the free use of fans, have 
already Improved the health of persons following this 
occupation. 

Extraction 0/ Gold from the Ore : Cyanide and Mercurial 

Processes 

Gold is extracted from the ore by the battery and 
cyanide methods. ( Vitle also p. 225.) Over crushed ore 
which has been placed in a vat a solution of potassium 
cyanide is poured, varying in strength from "OS to CTS per 
cent, and after an exposure of from 12 to 24 hours or 
more, according to the character of the ore, the cyanide 
solution is run ofT. The cyanide liquor contains the gold, 
probably in the form of a double salt The solution ts 
caused to flow over pure metallic zinc shavings, when the 
i;rold is deposited ax a slime on the zinc This slime is 
rcmnved, roosted, and smelted, when pure gold is obtained. 
During the earlier OjXTation.s ihe hands of the workmen hax-c 
to be dipped from time to time in the cyanide liquor, and if 
tlie immersion is frequent or protracted the skin of the hands 
and arms becomes the scat of a "scabby" rash. The men 
are frequently provided with long indiarubber gloves, but 
these are not always worn, either through indifference or 
because they get torn. In hot weather the air in the neigh- 
bourhood of the vats is strongly impregnated with the 



METALLIC POISONS, DUST, FUMES, ETC. 237 

cyaiv^en vapour, to which some men, especially white men, 
appear to be extremely susceptible. Many of the white men 
employed at the vats sufTer from severe headache, nausea, 
and inability to take food. The dark races do not similarly 
suffer. The KaBirs occasionally suffer from the skin eruption 
on their arms and hands, but they do not experience the 
severe headache, which in the white men may last for two 
days, attended by a distaste for food and by insomnia. 
Aperients relieve these symptoms, but the best results are 
obtained from antipyrin or phenaccUn and caffeine. Owing 
to the responsible nature of the work and the money value 
of the product, only one or two white men are allowed 
rcf^larly to undertake part of the work, but it is the dark- 
skinned men who have to dip their hands ilecpc:it down into 
the slime and do the cleaning up. 

Gold ore may be treated in another way. After having 
been crushed it is driven by water upon amalgamated copper 
plates which have been smeared with mercury. The gold 
unites with the mercury. This is scraped off at intervals 
and retorted. During the process of retorting mercurial 
fumes are given oflT, the inhalation of which is the cause of 
the falling out of the teeth and hair of the workmen, the 
excessive salivation and the tender }^ms, for which the men 
arc obliged to use mouth-washes and gargles of potassium 
chlorate. 



Emtry-whetls 

In the grinding of steel by emery-wheels large quantities 
of dust are given off, and occasionally a wheel breaks. When 
this accident occurs the fragments, owing to the speed at 
which the wheel i» running, are thrown off with very great 
force, and often inflict serious injury. The wheels are made 
from emery rock, an extremely hard stone imported from 
Smyrna and the island of Naxos. The stone is an anhydrous 
oxide of aluminium with Sint, silica, and iron. Grinding- 
wheels arc sometimes made from another stone called corun- 
dum, which is also an oxide of aluminium, and is as hard as 
emery. In either instance the rock is ground by heavy 




238 



DISEASES OF OCCUPATION 




rollers into fine powder. This is collected. A considerable 
amount of dust is generated during the crushing, but as this 
is carried on in encased machinery the workmen arc not 
exposed to the dust to any extent. 

Emcrj'-whccb arc made of crushed emery-stone along , 
with such binding substances as shellac, indiarubber, oil^M 
sulphur, and silicate of soda, all pressed firmly to<;ether in^^ 
a mould under hydraulic pressure. Into many of the wheels 
brass wire-webbing is inserted, so that should a wheel break 
when running there would be less risk of fragmentation 
taking place. Emery-whccIs have to run at great speed. 
They frequently make as many as 7,000 revolutions in 
minute. The wheels are used for shaping the handles 
knives, and as the handles of knives are held together by 
steel rivets and tangs, large quantities of steel and emery dust 
are given off", the inhalation of which by the workmen is un- 
avoidable unless respirators arc worn or suction provided for 
drawing the dust downwards nnd away from the face of the 
worker. The emery-wheel — called in the trade the " cutler's 
glazcr" — was introduced into Sheffield about thirty years 
ago, and it is maintained that since the introduction of tb 
"gla2er" cutlers, as a class, have become even more un 
healthy than they were in previous years. 

Recently several steel -grinders working at emery-wheels 
have consulted me on account of soreness and dryness of the 
throat, which they attribute to tlie dust given off by the 
emery-wheels. It is a common complaint among the hands 
working in a particular shop thnt even the men who are not 
employed in grinding suffer equally owing to the dusty 
atmosphere. The throat becomes dry and sore and there 
created an intense thirst and a desire to drink. The fauces 
are obscr\'cd to be diy, red, and irritable. In addition to 
the dust, the men complain of a very disagreeable odour 
given off by some of the emery-wheels. 1 liave met with 
one or two cases of pulmonary phthisis among the younger 
men, but how far this is related to the work and the throat 
condition I am not prcpaK-d to say. By keeping the men 
off work fur a week or ten days the throat symptoms 
usually disappear. 



,rs , 



■* 




METALLIC POISONS, DUST, FUMES, ETC. 239 

Manufacture cf Galvanised Iron 

This is an industry which is lai^ly confined to Birmingham 
and the Black Country. Before being galvanised the sheet- 
iron and hollow-ware have to be " pickled." ThLs con.sist<t in 
plunging the iron into a solution of hydrochloric acid, which 
cleanses the iron. During this process pungent fumes arc 
gi%'en off which arc extremely unpleasant and distinctly 
irritant. The metal is thereafter plunged into the galvanising 
bath, which contains molten zinc or spelter. Upon the surface 
of the molten metal handfuls of ammonium chloride arc from 
time to time thrown to prevent oxidation. When the am- 
monium chloride is thrown on clouds of thick white smoke 
arise By persons regularly following this occupation the 
fumes given oflT in both these processes seem to be on the 
whole well home, but to a new hand they are extremely 
irritating and causative of cough. The work is dirty ; there 
Is a good deal of smoke, and the fumes hang long about the 
workshop. There ought to be very free ventilation. The 
men who follow this occupation suffer from rheumatism and 
bronchial a/Tections owing to the work being carried on in 
buildings that of necessity are more or less draughty. 

Tin-pta(t Worktrs 

In the tinning of canisters, iron boxes, &c., the iron is 
dipped into a bath of molten tin, whereby a lustrous white 
coating is obtained. The process was introduced into Wales 
from Saxony more than two centuries ago. Tin-plating 
is an industry still largely confined to Wales. In Mon- 
mouth, Glamorgan, and Cacrmarthcn the largest works are 
to be found. The beautiful valleys of those counties have 
been spoiled by the smoke from the works. In order to be 
tirmed iron plates have to be specially prepared. Tbcy 
have first to be cleansed by being washed in water, and after- 
wards they are " pickled," »>., immersed in a sulphuric acid 
bath. On removal from the bath the plates arc rubbed with 
dry bran or a mineral powder to remove any grease and to 
give a polish to the surface. Tin-plate mills are, practically 




340 



DISEASES OP OCCUPATION 



I 



speaking, open to the air, and through them there sweep 
cold winds, so that the persons employed are exposed to 
chilling draughts. The lifting and carrying of the iron 
plates is hard and heavy work. Mr. Whymper, H.M. 
Inspector of Factories gave, in the Annual Report uf the 
Chief Inspector of Factorie:>, l88S, a graphic description of 
an industry which remains to-day what it was thirty years 
aga The account of the work furnished by Miss Rose 
Squire, H.M. Inspector of Factories, is a piece of sorrowful 
reading. The work is hard, dusty, and wet. In the large 
milh there is a commingling of the sexes which is beyond 
supervision. In washing the plates the women become 
thoroughly soaked. It is impossible for them to keep their^ 
skirts, underclothing, and boots dry. An equally wet, ua- 
wholesome, and somewhat degrading occupation is that ol 
the girls who have to carry the iron plates to and from the 
pickling bath, in which the plates arc dipped in sulphuric acid 
solution. The girls are literally soaked throu^ to the skin 
by this acid solution, which destroys their clothes. The 
fumes given off by the sulphuric acid arc unpleasantly strong, 
and pervade the whole of the works. For the removal of 
the fumes and tlie steam the workpeople rely upon the 
draughts through the mill dispersing them. The work- 
people suffer from inflaium.ltory affections of the eyes, 
accompanied by a discharge, dryness of the throat, nausea, 
and giddiness ; the teeth become black in consequence 
of the sulphuric acid fumes, and the hair falls ofl*. Occa- 
sionally the girts wear a handkerchief over their mouth a.s H^J 
protection. ^| 

Girls and young persons from fourteen to eighteen years ' 
of age arc employed in the tin houses in rubbing with bran, 
or some other powder, the imitfd plates, so as to remove 
any grease that may be present and to give them a polish. 
Machinery is being gradually introduced into the mills, and 
is supplanting hand-labour; but no matter by what means the 
work is done, there will always be a considerable amount of 
dust raised into the air, which, with exposure to llic chilling 
winds sweeping through the mills, will render the workpeople 
liable to pulmonary troubles and bronchitis. The heavy 




METALLIC POISONS, DUST, FUMES, ETC. 241 

burdens which some of the young girls are forced to cany 
ought to be lightened, as the weights are far beyond their 
strength and physical development It is not uncommon to 
find in the tin-plate works of South Wales girls carrying iron 
plates from 40 to 100 lbs. in weight 



CHAPTER IX 

DISEASES DUE TO OKGANIC AND INORGANIC HUST, HEATED 
ATMOSPHERE, ETC 



Dust 

DUST is the enemy of the workman. Much ill 
and most of the industrial diseajcs arc caused by the 
inhalation of dust or by the workpeople swallowing it 
along with their food. Oust, if insoluble, may inflict injury 
mechanically ; if soluble, it may cause poisoning, as in , 
plumbism. In the various industries dust of all kinds 
met with. It is inorganic and ot^anic. The dust given off 
during the chiselling of stone, the grinding of steel, and thci 
packing of pigments is inorganic, while that raised durit 
the manufacture of cotton, silk, and jute b organic. DU5ts| 
that are harmful might be spoken of as mechanical and 
irritative, chemical and toxic, or caustic. 

Huw to deal witli the dust on our roadways and streets is 
a problem that will sooner or later have to be seriously faced, 
for the increasing employment of motor-cars, motor buses, and 
locomotives is the cause of an amount of dust being thrown 
into the atmosphere such as has never previously taken place 
in this or any other country. What is said of the open road 
applies with equal cogency to work on underground railways. 
The Rapid Transit Railroad of New York runs for twenty- 
one miles under the city. There is a suspicion that the dust 
of this subway has an injurious effect upon the men who spend 
the greater part of the working day therein. Dr. G. A. Soper, 
Consulting Sanitary Engineer of New York, has, in the 
Medical Rtcord, April, 1 906, published a report upon the air 
and the dust in this subway. The temperature is 5° F. 



ORGANIC DUST, ETC. 



243 



thnn that of the streets in summer, and in winter it is i&> F. 
higher. Whether the increased temperature is anything 
more than disagreeable remains to be seen. There is the 
risk to passenger:^ when standing at overheated underground 
stations, of their becoming chilled by the cold draughts that 
occasionally blow through the tunnel. Samples of air were 
taken from the underground railway for analysts and com- 
pared with those of air from the streets. About eighty oxygen 
determinations were made; the average for the subway was 
20*6 per cent, by volume, and for the outside air Z07 per cent 
The oxygen difference between the two is therefore small. 

More than 2,000 analyses of the air of the subway were 
made in order to determine the amount of carbonic acid or 
carbon dioxide present. At no time was the amount of COj 
large ; the greatest amount was 8*89 volumes in 10,000 volumes 
of air. It is interesting to know that the amount of CO> 
apparently fluctuates in subways at diflcrcnt hours of the 
day and night, and that even in the streets there is pcrhajw 
a seasonal variation in the amount of CO, present. Mr. 
Sopcr says: "It may be a surprise to many to know that 
when the trains are moving the air circulates not only in and 
out of the subway but from station to station with remarkable 
freedom, and that there is but tittle more carbon dioxide in 
the air between the stations than at the stations themselves." 
There is always a certain amount of air in the subway that 
is not immediately forced into the streets by the trains. 
Examinations were made of the number of bacteria present 
in the air of the underground railway and of the streets- 
There were 3,200 bacteria pvr cubic metre in the air of the 
aubway and 6,500 in the streets. The microbes found in the 
subway probably came from the streets, for they varied in 
number with those of the streets and were more numerous in 
the underground near the stairways than at the ends of the 
stations. The dust, too, that was carried down the stairu'ays 
by inrushing currents of air always contained more micro- 
organisms than the dust of the subway, and there were alw.t)'s 
more bacteria at tbc end of the station platforms where the 
trains departed from than at the arrival end. How far these 
bacteria were pathogenic, and what their origin, it is tmpos- 



sible to say. They are always present in large numbers 
where human beings congregate, and yet the bacteria were 
fewer in the underground than in the air of the streets. Some 
of them are probably harmful. In the absence of sunlight in 
the subway the longevity of pathogenic micro-organisms is 
increased. Pneumococci, which arc the cause of pneumonia, 
lived in the sub^^ay 2 1 days but only 4 days in the streets. 

On examining the dust of the underground, it was found 
on chemical analysi-s to contain 6i'30 per cent, of iron, nearly 
all of which wa.s in the metallic state, 31*94 per cent of 
oi^anic matter of vegetable and animal origin, iS'jS per 
ccnL of silica and other matters insoluble in acid, and ri$ 
per cent, of oil. There were on an average 61 '6 milligrammes 
of dust in 1,000 cubic feet of air; the maxiinum weight was 
204 milligrammes. Compared with the dust in the streets, 
that of the subway was 1 1 to 800 per cent heavier. While 
some of the dust in the underground is carried in from the 
streets, much of it is of underground origin, and comes from 
the gradual wear and tear of the wood, cement, and other 
materials that have been used in construction, also from the 
operation of the trains, for the lai^cst percentage is iron dust, 
and is due to the grinding action of the powerful brakes on 
the cars. The loss of weight in the brake-shoes alone is 
estimated to be about one ton per mile per month, and when 
there is added to this the loss from the wheels and the raiU 
way track, the origin of the metallic dust is readily explained. 
It is the finer dust only that rises into the air of the under- 
ground, but it is the breathing of the fine dust given off in 
certain trades, e^.. steel, scissor, and needle grinding, that is 
the cause of fineumokonmis, or that form of lung disease 
which terminates in fibroid phthisis. What the effect of the 
inhalation of the dust is upon the health of the men employed 
on the underground there has scarcely been sufficient length 
of time to show, but the conditions which are present point 
to the advisability of a railway company which controls both 
underground and surface running giving alternate employ- 
ment to the men, so as not to have them always in the subway. 
Although no serious disease has been found in the men, yet 
•laany of them suffer from inflammatory affections of the nose. 



I 

4 



4 
4 




ORGANIC DUST, ETC. 



MS 



throat, and wiadpipc, and also from " dr>- pleurisy " unaccom- 
panied by pain. 1 have dealt at length with Dr. Sopei^s 
article because it is ttic most complete study of the subject 
that I have met 

It goes without saying that some trades are dustier than 
others. The amount of dust in a cubic metre of air will vary 
from o mgm. in the clean air of a dwelling-house to 175 mgms. 
in such an Industry as felt-shoe making. In a dusty trade 
like cement.making Arens " found, when no work was being 
dooe, 130 mgms. of diut in 1 cm. of air; and during work, 
when the crushing machines were running, 224 mgms. 
According to Hci^se,' a workman following his occupation 
for ten hours a day would inhale the following quantities of 
dust in grammes : — 



Horsehair works 
Sawmills 
flour mills ... 
Iron foundry 
Tobacco wofks 
Chemical vrurki 



One of the dangers to health attendant upon following a 
dusty occupation is the development of lung disease which 
terminates in fibroid phthisis; hence the term "stone- 
masons' phthisis," "steel-grinders' phthisis," and "potters' 
rot." Inhalation of gritty dust is the cause of the struc- 
tural changes wliich occur in the lungs. Calmctte, of Lille, 
has recently di.sputcd the respiratory origin of pneumo- 
koniosis. He is of the opinion that the fibroid disease of the 
lungs is the result not of workmen breathing irritating particles 
of dust, but of swallowing them with their food, and that the 
dust particles, penetrating through the lining membrane of the 
alimentary canal, find their way into the lymphatics and are 
carried by these canals to the glands in the abdomen and 
also to the lungs. Calmctte pleads for an inteatinal as against 
a fesptratory origin of the disease While in no way denying 

■ Arthtv.JUrHygien*, i&w. 

» Vttrttti. I. Ceniht. itta. N.F., vul. 36, p. 339. 



PcrDijr. 


jMDagnpMTMr. 


0-05 


»5 


o*og 


3J 


0't35 


375 


0-14 


4* 


0-36 


108 


t'l2 


SS6 



246 



DISEASES OF OCCUPATION 




saryH 



that, as in the case of pathogenic micro-organLsms, dust may 
reach the lungs j'ld the intestinal canal, facts and clinical 
experience alike point to the respiratory passages as channels 
also by which du«t reaches the lungs. It is only neces 
to examine, cither by the naked eye or microscopically, the 
expectoration brought up by a man who has been working 
in a dusty atmosphere for a few hours. In addition to 
particles of dust imbedded in the mucus, smaller particles arc 
seen in the interior of the mucous corpuscles and epithelial 
cells. The respiratory passages are lined by a layer of ciliated 
epithelial cells, whose function it is, owing to the to and fro 
movement of their ciliary processes, to waft outwards particles 
of dust that have been inhaled. Were it not for this pro- 
tective barrier, dust would reach the lungs much more 
fretjuently than it does. The effect of recurrent colds and 
bronchial catarrh is to cause shedding of these cells, and 
consequently a loss of their protective influence. With this 
gone, dust more readily reaches the lungs, and entering the 
walls of the pulmonary alveoli, it induces a low form of inflam- 
mation which ends in the transformation of the spongy 
substance of the lung into hard, unyielding fibrous tissue, 
quite unfitted fur the purposes of respiration. On the dust 
reaching the hmgs several of the finer particles are taken 
up by large cells which come from the walls of the alveoli, 
and these cells, known as phagocytes from their power 
eating aiid thereby destroying microbes, have also the power 
of absorbing dust particles. Phagocytes arc endowed with 
certain amount of moWlity. They pass through the wall of 
the alveoli and, reaching the lymphatics of the lung, either 
deposit the pigment within them or in the surrounding tissues, 
or they carry them to the bronchial glands at the root of the 
lungs. The (ibrotic lung disease that is induced through in- 
halation of dust extended over a length of time is in the 6r3t 
instance a non •tuberculous disease, but as the malady is of 
slow development and the man keeps to his work and is 
tliercby exposed to accidental infection, the opportunity U 
oflbrded of the tubercle bacillus becoming grafted upon thi 
chronic inflammatory affection and of converting it into one 
of a tuberculous nature. 



En 



If I 



ORGANIC DUST, ETC. 



247 



There are various forms of dust diseases of the lungs, or 
pneumokonioses, e.g., hnthracosis, due to coaUdust ; chalicosis 
and silicosis, due to sandstone and mineral grit ; siderosis, due 
to iron ; and byssinosis, to cotton fibres. 

The following table taken from Sommerfield's book on 
diseases of occupations shows the important part played 
by dust in causing pulmonary phthisis : — 





Number of Deaths 


Number of Deaths 




due to Phthisis per 


due to Phthisis per 




1,000 Persons. 


1,000 Dtsths. 


Occupation without production of 






dust 


3*39 


381-0 


Occupation with production of dust 


5 '42 


48o'o 


Population of Berlin of same age . . . 


4-93 


332-3 


Trades giving rise to — 






A. Metallic Dusts : 


5-84 


470-6 


(a) Copper trades 


5'3' 


52o'S 


(^) Iron 


555 


4037 


if) Lead , 


779 


50'7 


Trades giving rise to — 






B. Mineral Dusts : 


443 


403"4 


Pottery Workers 


i4'o 


5910 


Masons 


4*26 


382 


Trades giving rise to — - 






C- Organic Dusts: 


5 '64 


53704 


Dust from Leather, Skins, and 






Feathers ... 


445 


565'9 


Dust from Wool and Cotton... 


5'35 


5 54- 1 


„ „ Wood and Paper... 


5-96 


507-5 


„ „ Tobacco 


8-47 


5984 



British statistics are equally interesting. In the table on 
p. 248, which is extracted from Dr. John Tatham's interesting 
article in " Dangerous Trades," p. 135, we observe that there 
are several industries in each of which the mortality from 
phthisis and diseases of the respiratory organs is more than 



DISEASES OF OCCUPATION 





Cnmpuitive 

MurUUty 

Ficurei 

(AU CM*ei>. 


MoaTALrrr Figurb. 


OcnpatkiB. 


fhikbik 


Rcsfrinilatf 


Agriculturist 

Polteiy : Enrthenware Manu- 


Soa 


106 


IIS 


^cmrc ... 

Culler 

Tile Maker 

Cbus Mnker 

Copper Worker 

Iron and Steel Afanufacturc 


1,706 

i,8to 
l»487 

'.30' 


33$ 

401 
=95 
»94 
'95 


66« 
5i« 

445 
406 

450 


Stone Quarricii 

Brass Worker 


1,176 
i,oS8 


369 
379 


307 

»73 


Chimncj'-swcep ... ,„ 

I*ad Worker 

Cotton Maiiufacture 


1.783 
1,141 


360 
148 

302 


*9i 
3J8 



double that of ae^rtculturists, and that in some of the trades 

tKc total mortality from these discaiic!. ranges from three to four 
and a half tiraes that of the agricultural cla&t. 

The opinion is not put forward that the high mortality of 
dust-producing occujKttions compared with that of agricultur- 
ists is due alone to irritation of the lungs caused by dust, for 
there arc doubtless other contributing causes. Still it must 
be acknowledged that the influence of dust in inducing respira- 
tory diseases of a purely mechanical and irritative nature 18 
considerable, ^ witness pottery manufacture, steel-grinding, 
and file-making. 



Ccl/an 

If we leave out of consideration the eflfects of the moisture 
artifidally introduced into weaving-sheds, it cannot be said 
that the manufacture of cotton is per st an unhealthy 
occupation. Much of the bad health of the workers has 
been the result of the reckless manner in which the moisture 
has been applied. In the preliminary processes of the manu- 




ORGANIC DUST, ETC. 



249 



jre of cotton, such as emptying the bales of the raw 
material, "carding," "roving," "spinning" the yarn, and 
"winding" it, there Is often a consitlcrablc amount of dust, 
but the air-space in which the work is carried on is generally 
good and the ventilation is cITcctivc. In the spinning-room 
the temperature is usually higher and the atmosphere is not 
so pure as in some of the other departments of the mill. The 
temperature may rise to go* or even I0<y> F., and as no mois- 
ture is added the air is uncomfortably dry. The opinion 
that previously prevailed as to the necessity of excludmg 
moisture from this department is losing ground, and ventila- 
tion is being improved. Owing to the fact that dampness is 
conducive to good weaving this particular process is carried 
on in one-storied buildings. Factory owners build their 
weaving sheds as far as possible tn damp situations and with 
only stone flags placed upon the soil to form the floor of the 
shed. Moist exhalations from the soil arc thereby encou- 
raged. But for moisture and warmth in the mills the cotton 
threads would become brittle. The roof is formed by a 
series of bays, and as the buildings receive their light 
from the north side of the bays no direct sunlight is 
admitted into the shed. Or. James Wheatlcy, in dealing 
with the health conditions of the cotton -weavers, states that 
the principal factors concerned arc (1) fouling of the air 
breathed by the woritcrs themselves, combustion of gas, 
dust, and emanations from the soil ; (2) excessive humidity; 
(3) ^'S^ temperatures; and (4) want of cleanliness. To 
these might be added the risks of sore throat, bronchitis, 
and phthisis by the habit weavers have of sucking the weft 
through the shuttle when the thread breaks or on rcplen- 
ishing the shuttle. The shuttle might become infeclwJ by 
tubercle bacilli. Several devices have been introduced to 
obviate the necessity of putting the shuttle to the mouth, 
but the weavers adhere to the simpler but more dangerous 
practice. 

During four years of my early professional life spent 
in Preston, Lancashire, I saw much of the cotton operatives 
and their work. Thirty years aRO the death-rate of cotton 
operatives from pulmonary phthisis was much higher than 



350 



DISEASES OF OCCUPATION 



it is to-tlay. During the last twt) decades there has been 
all through England a diminution in the mortality from 
phthisis. Workers in cotton milts have shared in this 
declension, although figures show that only a few years ago 
theywcrc still suffering from phthisis to a greater extent than 
persons not similarly employed. The mortality statistics of 
the town of Blackbiini furnished by Dr. Wheatley indicate 
that as regards phthisis there is a diflcrence which h in favour 
of the male population of the town not cngE^ed in cotton 
manufacture; 





Cbttoa- 


Occupied 

M>i«r 


as " 35 y^rs 

35 W 45 

45 to 55 .. 
55 to 65 „ 

65 upwards ..■ 


i;a 

311 

i-sa 
ris 

J-4S 


348 


9-31 

n€ 

"•43 

0-47 



It Is pointed out hy Dr. Alfred Greenwood, Medical Officer 
of Health for Blackburn, that since 1S91 there has been 
a steady diminution in the death-rate of cotton operatives, 
and that with one excepted agc-pcriod affecting female 
weavers from 45 to 55 years of age, when the rate increased, 
the death-rate from phthisis has declined. Dr. Greenwood's 
Rgures, which deal with the years 1S91 to 1905. indicate that 
the conditions under which cotton operatives are working 
are better now than at any previous time in the history 
of the industry, and as a consequence the mortality rate has 
diminished, the health of the operatives has been better, and 
there has been a larger output of manufactured goods. 

Persons following dusty occupations occasionally suffer 
from lung diseases of a distinctly chaiacterbtic type, attended 
by an increase of the fibrous tissue of the organs, to which 
the term pneumokoniosis is applied. Under this term all 
lung diseases caused by dust arc included. The dust may 
be of %-arious kinds, e.^., organic and inorganic. To the 



ORGANIC DUST, ETC. 



35" 



lung disease caused by the inhalation of cotton particles, 
the term "byssinosis" is applied, but in cotton operatives 
a purely dust disease is seldom met with. In Lancashire the 
deaths from phthisis of cotton operatives were 25 per cent, 
of the total deaths in the years 1880-S2 ; in the years 1890-93 
the percentage had fallen to I9'6. 

The improvement in the health of the cotton operatives 
and in the factory conditions during recent years is most 
gratifying. Prior to the year 1882 cotton yarns were 
over-sized, and this necessitated the introduction of a con- 
siderable amount of steam into the wcaving-sheds to soften 
the thread. The over-sizing not only added to the weight 
of the cotton cloth and was wrong from a moral point of 
view, but it was harmful to the workpeople owing to the 
dust and flocculent material which were given off. The 
excessive use of steam caused the clothes of the workers 
to become damp and was a source of rheumatism and 
pulmonary complaints. The Health Committee of the Black- 
bum Corporation instituted an inquiry in 188S which con- 
firmed the statements made by the Medical Officer of 
Health, Dr. Stephenson, as to the injurious influences of the 
ineffectual ventilation of the mills and of the excessive steam- 
ing upon the health of the workpeople. These reports led 
to the parsing of the Cotton Cloth Factories Act in 1889, 
whereby manufacturers were prohibited from exceeding 
certain limits of moisture and were obliged to have always 
two hygrometers in each wcaviiig-shcd. Schedule A of 
the 1889 Act states the maximum limits of humidity of 
the atmosphere at given temperatures. Although this Act, 
one of whose requirements is the provision of 600 cubic 
feet of fresh air per person per hour, was followed by good 
results from a health point of view, it did not satisfy the 
Weavers' Associations. The request was therefore made 
to have "steaming" abolished entirely. A careful and 
extensive inquiry was made into the whole subject by a 
Committee composed of Sir Henry Roscoe, Sir Wlltiaro 
Roberts, and Dr. Ransomc, who reported to the Home 
Secretary in 1897. In the following year the recommenda- 
tions of the Committee were embodied in a Statutory Order. 



as* 



DISEASES OF OCCUPATION 



The Committee rccommeiwicd the employment of pure 
water drawn from a public supply, or such other source 
an is deemed satisfactory, for the purpose of inducing 
artificial humidity, and that when the source of the water 
supply is doubtful measures shall be taken to purify it 
before introducing it as steam, also that during working 
hours the proportion of carbonic acid gas In the air shall 
be not greater than 9 volumes to e\'ery 10.000 volumes of 
air. No alteration, practically speaking, was made of the 
amount of moisture previously allowed. Where pains were 
not taken to regulate the introduction of steam the air of 
the weaving-shed would become foggy and the steam would 
condense on the walls and pillars of the weaving-shed. 
The clothes of the workers too became saturate<l with 
moisture, so that on leaving the warm weaving-shed and 
proceeding homewards on a cold evening, the workpeople 
frequently got chilled anil became liable to bronchial and 
pulmonary complaints and to rheumatism. Compared with 
dry air. which is regarded as bracing, moist air is enervating 
and unfits the individual to bear fatigue, and as several 
of the cotton operatives are {xwrly clad and ill-fed the 
ill-health they suffer from is easily explained. Another 
risk of getting chilled lies in the fact that when the 
clothes of the workpeople are damp they become perme- 
ated with the "size," and as this may contain a fairly 
large quantity of deliquescent salts the clothes, already 
damp, become further attractive to moisture. 

Add to the humidity of the atmosphere a high tempera- 
ture and impure air, and white it is easy to understand 
how much reduced may be the vital resistance of the 
cotton operatives, it is difficult to say huw much of 
the ill-health is due to excessive "steaming" and how much 
to accessories. Work in a hot, moist atmosphere becomes 
uncomfortable and oppre&w've simply because the evaporation 
of the skin is interfered with, and thereby one of the 
natural methods of cooling the body is prevented. 

Experience has confirmed the wisdom of the recom- 
mendation of 9 volumes of carbonic acid per 10,000 of 
air, Altliough a higher standard of purity might have 



i 




ORGANIC DUST. ETC. 



253 



;n nsistcd upon, the regulations have, on the whole, 
worked satisfactorily. To enable the standard of 09 per 
1,000 to be maintained, it is necessary to introduce more 
than 2,000 cubic feet of air per head \Kr hour. Generally 
speaking the ventilation of cotton -wca%'ing sheds is good. 
It only requires that the electric light should replace other 
methods of artificial lighting, that effectual means exist for 
the removal of dust, and due rc^rd be paid to the adequate 
provision of sanitary conveniences for the workers not closely 
contiguous to the weaving-sheds, also that the surroundings 
of these sheds should be as healthy as possible, so that only 
pure atmospheric air shall enter the factory. 



Fiax and Linen 

An old Irish industry, the manufacture of linen, was 
revived by French Huguenots who settled in Helfast, Lurgan, 
and Li^^burn more than two hundred years ago. Although 
farmers in the North of Ireland grow flax, they arc obliged 
to buy the seed from Holland and Russia, for owing to the 
custom of pulling the ftax early and of steeping it in water 
the local growth is all made use of and is not allowed to 
run to seed. In the spinning-room of a linen factory there 
is considerable moisture, partly owing to the spray thrown 
off during the process of "wet" spinning when the yam 
is being twisted round the bobbins, and also to the presence 
of steam jets. As In the manufacture of cotton, the flax 
yarn, before being woven into cloth, is stifTcncd or sized 
by a mixtufc of caragheen moss. Hour, and tallow, and in 
order to dry the yam as quickly as possible the temperature 
of the room is generally high, go^ F. to 125° F. 

The work in linen factories is hard, the workrooms are 
hot, and the atmosphere in some of the processes is too 
moist and in others too dusty. The hecklers, «>., the men 
who dress and sort the rough fiax converted into tow by 
having been passed through a machine, frequently suffer from 
dryness of the tliroat and bronchitis attended by cough and 
shortness of breath. In this, as in all dusty occupations 
where there is dryness of the throat produced by dust, 



354 



DISEASES OF OCCUPATION 



I 



the tncn indulge too freely in the use of alcoholic stimulants. 
The machines in the heckling department are attended by 
young lads, many of whom arc half-timers, and although 
the occupation is dusty respirators are no longer worn with 
the same frequency as formerly. Accidents are not unknown, 
for the lads occasionally get caught in the machinery. 
Workers In the spinning -rooms suflfer from headache and 
vertigo owing to the great heat As the workers have to 
stand all day more or less on wet floors, they frequently 
suffer from v-aricosc veins in their l^s, cedema of the 
feet, and eczema. Dr. Gilbert, Medical Factory inspector, 
of Belgium, tells me that in Belgium many of ike flax 
workers suffer from a peculiar abrasion and ulceration of 
the skin of the palmar surface of the band owing to the 
irritant cflect of some of the materials in the liquid used 
for spinning. The skin cracks and is exfoliated without 
pain or any sense of irritation, but as the true or deeper 
skin is kid bare painful prickling is experienced. Occasion* 
ally the ulceration tends to invade the deeper tissues, and 
while the character of the sores recalls the appearances met 
with in syphilitic ulceration they are not in any way related 
to this specific disease. Tlic ulcers are purely the result 
of a local dermatitis peculiar to flax workers Dr. H. S. 
Purdon, of Belfast, who had several years* experience of 
the maladies of linen workers, states that he is familiar 
with the ccKma observed on the hands of spinners but 
has never come across the ulcers on the hands to which 
Dr. Gilbert, of Brussels, has drawn attention. The method 
of preparing the flax is probably different in the two - 
countries. ^H 

Many persons on beginning work in a linen mill for the ^^ 
first time suffer from malaise, known as "mill fever," the 
symptoms of which are nausea, vomiting, headache, and a 
rise of temperature. Usually the indisposition lasts two or 
three days. It is attributed to the disagreeable odour given 
off by the oil and to the stifling and moist atmosphere of 
the workrooms. 

Dr. Purdon mentions a peculiar skin eruption, not unlike 
small-pox, which attacks Uie forearm, arm, and face of the 



ORGANIC DUST. ETC. 



255 



doflers, i.t., the boys and girln, usually half-timers, who 
remove the full bobbins from the spinning frames, and which 
is the result of the irritant action of the flax, oil, and water 
upon the skin. Callosities are met with on the index fingers 
of the hecklers, and arc the consequence of the pressure 
and friction caused by pulling the flax out of the "pins" 
of the machinery. Many of the spinners aufler from a painful 
aflection of the nails of the great toe. This onychia, or 
inflammation of the nail, is the result of infection caused 
by the operatives working barefooted on the wet floor of 
the apinning-roora. The Regulations of the Home Office 
have done much to improve the health of the operatives 
and the condition of labour in linen factories in recent years. 

Jfile 

Whether the prosperity which has attended the jute trade 
in the past will be extended into the future it is impossible 
to say. The manufacture of jute made Dundee one of the 
most prosperous towns in the United Kingdom. In 
Dundee is manufactured nearly all the jute that is imported 
into this country. Roughly speaking this industry gives 
employment to 40,000 persons. Many of the jute mills were 
built in the heyday of prosperity and arc weil equipped. 
The vegetable fibre from which jute is made comes from 
India. The plant, an annual, grows in great luxuriance on 
the mud banks and islands of the great rivers of our eastern 
dependency. Mr. H. J. Wilson, H.M. Inspector of Factories, 
has written excellent reports upon the conditions of labour in 
jute mills. About3,soo,000 bales of jute arc exported annually 
from India to Europe, and it is estimated that 2,900,000 
bales are used in Calcutta and neighbourhood in the 
manufacture of cloth and sacking. The jute exported from 
India is distributed as follows : 1,900,000 bales come to the 
United Kingdom; 1,000,000 go to the Continent; and 
300,000 bales arc sent to America. 

Jute is used for making sacks and coarse twine. Attempts 
have been made to manufacture it into carpets, but as these 
have very little wear in tltem the utility of jute in this 



J56 DISEASES OF OCCUPATION 

respect is far outstripped in sack -making. I 
been in such noisy factories as the jute mills of ] 
The machinery is .<iiniilar to that employed in line 
but judging from the annual returns there arc more a 
in jute than in textile factories generally, a circui 
which may be padly explained by the less perfect 
of protection adopted. Alterations lately introduce 
materially diminished the number of casualties. $ 
the processes of manufacture, such as those of prcpar 
spinning, are extremely dirty and dusty, and as the « 
these departments arc lower than in the weaviag-ro< 
operatives are of a distinctly inferior class. The du! 
off by the raw material is irritating to the respirat< 
sages, and in order to reduce its effects many of the 
hands resort to the use of snuff. The exhaust fans 
carding- and spinning-rooms succeed in removing t 
the dust The temperature of the spinning-rooms is 
fortably high, and to cope with it the windows hav 
kept open and the fans runninf*. The application c 
the jute 6brc allays to some extent the dispersion of iJ 
it ofken creates an offensive odour arvd a feeling of d 
of the atmosphere when the temperature is high. 

The manufacture of jute cannot be regarded 
unhealthy occupation except in those department) 
considerable quantities of dust are thrown off. Man] 
operatives employed therein suffer from bronchial a 
monary troubles. The statistics of the Dundee In 
show that a large number of the workpeople suffi 
lobar pneumonia. There are few towns, unless it 
cast end of Glasgow, in which the children of the 
working classes suffer more from tuberculous affed 
the glands and bones than in Dundee. This is larj 
result of improper feeding and of the imperfect housi 
overcrowding that are known to exist in Dundee. 

As a consequence of the excessive noise of the i 
looms and of the spinning frames, aggravated 
diffusion of dust in the air, which aids in the formi 
plugs of wax in the ear, deafness is a common col 
of jute workers. The hoarseness observed in 




ORGANIC DUST, ETC. 



257 



itnployed in the preparing- and spinning-rooms may be 
the result of dust, and also the consequence of overstraining 
of the voice in speaking owing to the din of machinery. 
Many of the new hands suffer from a kind of "mill" fever. 
of which headache, vertigo, pain in the back, and a sense 
of extreme tiredness, accompanied by a rise of temperature, 
are the prominent features. The symptoms continue for 
two or three days, when they gradually subside with or 
without treatmenL 

Two or three years ago some jute workers in Dundee 
died from tetanus. On bacteriological analysis the tetanus 
bacillus was found in dual obtained from the machinery. 
The micro-organism bad come with the ve^jetable product 
from India, but the early detection of the microbe and the 
source from which it came led to an early extinction of 
the disease 

Although the manufacture of jute cannot be said to be an 
unhcaJthy occupation, since there is no disease specific to the 
employment, there is something, either about the occupation 
itself or the home life of the workers, that does not tend to 
improve the physique of the children bom to jute workers. 
To see a factory "scaling," as it is called, or the employees 
coming out at the close of a shift, is always an interesting 
sight, but such an event in Dundee offers the occasion 
for serious reflection. Many of the young persons employed 
in the preparing and spinning departments are of diminutive 
height and of light weight. There are a dwarfiness about 
them and a d^ree of imperfect physical development which 
at once strike the observer. Girls of scveiueen and eighteen 
years of age look from their size and build more like girls of 
thirteen. Many of them arc ana:mic and their frame is not 
well formed. It is dif^cult to attribute to its proper cause 
the stunted growth of young jute workers. Female labour 
in the factories with, as one of its attendant evils, the 
comparative n^lect of the children from a feeding point 
of view, the entrance of the children upon factory life 
at an early age, and the overcrowding in the houses are 
causes not to be ignored. 



DISEA&£S OF OCCUPATTON 



Buewmd: Rmltw and StmOlg Ms 



At the Mac 



occctog Of ibc 



AjMOCUtion, Autumn, 19C»; Dr. T. F. VaDD^ of 

AaaSO iA certain lyroplotns which be had obKrved 

worfchnE with » particnljw kincl of wood far tttHtc 

The men eomplataed of diynew of the tbraat maA of 

'******** * ' *"" of the eyes, which t***^** t^o or tfarec d^r&. 

Sooie of the wor ka ieo were raore sosoeptibte tb 

The wood ti known as Harcaibo bo n w o oJ or 

aad is fumbhed by a tree known as Tabebuta pexoapfajrlb 

of the order BigDOoiacez. The fine sawfinat caused 

hrihmmaiion of the tyta md Jjlatation of dK papOs.) 

The symptoou oocDplaiiied of are iIdAm- to tfaoac 
tnendooed hy me ■ as occ arrin g to j o ioer? who saw and 
chip tequoia wood, and resemhle those exhibited by p etaoBBi 
who aic suflfcrioe finNn a bad cold in the bead and cfactt, nz^ 
a running al the note, fr«quent fiu of sn e ejin g. srritatiaa 
in the throat aad brondd, aceocnpanjed bjr coogh, tabooted 
breathing and quickened poise, follawed by a sense of 
oppr«uJon at the stomach and accooipanied b/ a smarttog 
sensation in the eyes. The symptoms tisnally last only a 
day or two and arc mosUy observed in men wbo are wor k n^ 
with the wood for the first time. A tolerance seems to 
be established in regard to it except by men wbia are 
liable to bronchitis and asthma. Woonds caosod by 
splinters of the wood invariably suppurate and do not 
theal readily. The sequoia-tree is a conifer and grows in 
California. On several occaaioas f examined the sawdast 
bo<h chemically and microscopically without finding in it 
anything to explain the symptoms. The sawdust soaked in 
water dkl not give an acid reaction, nor did it produce 
symptoms in a rabbit, the floor of whose hutch was kept 
(trcwn «ith iL Rats were susceptible to sequoia sawdust 
Tbcy suffered from a running at the nostrils. 

Cotain kinds of wood have a bad reputation among 
joiners. Some tawdasts are more irritating than others, 

* " P aB UB f cas Trades,' p. 791. 



i^H 



ORGANIC DUST, ETC. 



259 



probably from the larger amount of inoi^antc matter which 
they contain. 

In Lancashire the dust piven off during the manufacture 
of shuttles for weaving purposes 15 a cause of malaise to the 
workmen employed. Many of them suffer from headache, 
coryza, excessive secretion of tears, and attacks of asthma. 
The wood from which these shuttles are made is known as 
West African boxwood, or Knysna boxwood, Knysna being 
the port in Africa from which it is exported. From the 
wood, Professor Han-cy Gibson, of Liverpool, and Professor 
Dixon, of Cambridge, obtained an alkaloid which, when 
tested experimentally, was found to be a cardiac depressant 
and also a paralyser of the motor endings of nerve fibres in 
muscles, similar in this latter respect to the action of the 
arrow poison, curare. 

The men who suffered presented a pale and jaundiced 
appearance ; thdr breath had a peculiar camphor-Iikc odour. 
Several of them bad attacks of difficulty of breathing 
and of precordial pain accompanied by cold sweating. 
There was also marked slowing of the heart's action. Since 
the alkaloid is soluble in weak saline solution, it is more than 
probable that it becomes dissolved on the perspiring skin of 
the workmen and is thus absorbed. 

Professor Harvey Gibson * has made a careful study of the 
wood and the alkaloids obtained from it. The wood comes 
from the Congo basin and the Cameroons. The cutting of 
the blocks of wood for shuttles is done by machinery and 
the finishii^ is done by band. It is principally during the 
sandpapering stage of the process that the fine dust is 
created which is supposed to be the cause of the indisposi- 
tion of the mca 

Messrs. Brady and Martin, chemists, Newcastle-upon-Tyne, 
extracted for me alkaloids and glucostdes from other forms 
of African boxwood, a few of which produced dilatation of 
the pupil but no marked constitutional efTecta. 

Poisoning by African boxwood is one of the industrial 
diseases recommended by the Workmen's Compensation 
Act's Committee of the Home Oflice for compensation. 
' Tkt Bw-Chemieal Journal, vol i., Ko. 1, p. 39. 



26o 



DISEASES OF OCCUPATION 



Workers in teak-wood occasionally suffer from dermatitis. 
Willmott Evans ' mentions the case of a joiner who had 
sufTered from a severe form of dermatitis attended by an 
eruption of an crythctno-vcstcular nature and of an extremely 
itchy character spread over the whole body, but especially 
abundant on the back of the hands, the £ace, and neck, and 
which, in spite of treatment, continued ten days. The eruption 
only came on after working in teak-wood. Eight years 
previously the patient had been identically affected after 
having been similarly occufned. Six of the eight men 
engaged in the workshop and working in teak suffered in 
tiie same manner, although less severely. The ^mptoms 
were attributed to the action of an essential oil which is 
found in the central part of the tree, and which gains an 
entrance into the body of the workman by the dust raised 
during the polishing of the wood. One of ray own patients 
who had been employed in tcak^wood suffered from vomiting 
followed by a vesicular eruption on the skin and a dciquama- 
ttve dermatitis, which was still in existence six months after 
the acute attack. 



Shoddy and Rag Sorting 

Shoddy has for its object the extraction of wool contains 
in rags. The industry is an old one. It is supposed to liave 
been introduced into this country by the Moors of Spain, for 
they are known to have made paper from rags. It was in 
1S13 that the shoddy industry was commenced in Batlcy, 
and for several yeant rags from all parts of the world found 
their way to this Yorkshire town, the "rag metropolis." 
Since the middle of last century shoddy factories have been 
established in Belgium, Germany, and France. Rags are 
divided into two kinds, ( I } cotton and linen rags, (2) woollen 
rafiS. The cotton and linen rags are made into paper while 
the woollen rags are converted into cloth. Although rags 
are gathered from all sources alike by clean and dirty persons, 
it is astonishing bow little sickness there is, comparatively 
speaking, among the workpeople who have to deal with them 
* SrifuJi y»unalof Dermalotogj, tgoj, December, p. 447. 



ORGANIC DUST, ETC. 



26] 



fn the factory. Woollen rags seldom convey infection, but 
cotton and linen rags have been the means of disseminating 
small-pox. 

Kjig-sortcrs are generally women. The work is anything 
but pleasant. This is especially the case with woollen rags, 
for they so frequently harbour fleas and other pests. All 
bundles of ri^^s before being opened ought, therefore, to be 
first disinfected so as to destroy parasites, and since rags from 
the surgical wards of hospitals and private patients often 
contain septic material, the importance of making disinfec- 
tion obligatory is at once apparent It is when the bundles 
arc first opened that the danger is greatest. The dust given 
off is irritating to the respiratory passages and causes drj'ness 
of the throat. During the grinding of the r^s by machinery 
considerable quantities of dust are thrown off. inhalation of 
which is extremely tr>'ing to new hands but which has little 
or no immediate effects on the older workpeople. Those 
persons who are new to the trade develop what is known as 
"shoddy fever." the symptoms of which are a rise of tempera- 
ture, severe headache, signs of bronchial catarrh, and running 
at the nose. The workpeople shiver as if they were going 
to have a severe fever, and they complain of muscular pains. 
The symptoms arc not unlike those met with in influenza. 
They rapidly decline on the workpeople absenting themselves 
from the factory for a few days, but they are apt. in many 
people, to recur on their return to work. Kags which contain 
a good deal of cotton have to be carbonised by being plunged 
into a bath of sulphuric or hydrochloric acid. By this means 
the cellulose or vegetable part of the fibre is destroyed and 
the wool can be thus extracted from cotton fabrics. When 
the rags are subsequently heated to dryness and are beaten, 
a considerable quantity of line dust is evolved, some of which 
is inflammable and may be the cause of an explosion. Dr. 
John A. E. Stuart, of Batley. says that the older workers 
suffer from bronchitis and emphysema of the lungs, that the 
dust in tbc air combines with the wax in the ears of the 
workpeople forming plugs and causing temporary deafness, 
that it induces granular inflammation of the eyelids, and that 
by plugging the ducts of the sebaceous gl&nds of the skin it 



254 



DISEASES OF OCCUPATIOM 



employed in other indoor occupations. During the mani- 
pulation of the dried tobacco for making cigars and 
cigarettes there is a good deal of dust floating about in the 
workroom, a circumstance which led Proust to include the 
manufacture of tobacco among the trades which causej 
diseases of the lung^ Zenker, a German physician, state 
at a meeting of German phys)cian» a few years ago that 
he bad found tobacco dust in the lungs of two persons 
who bad worked in a tobacco factory at Erlangcn, and 
although this 6nding has been supported by Merkel, tl 
discoveries remain isolated, so that we cannot regard pul-^ 
monary fo6aciesis as a common event. In Fiance, opinions 
are divided as to whether fccnalc tobacco workers arc not more 
prone to miscarry when pr^nant than woman employed 
in other industries, and whether the children who survive 
birth do not die in greater numbers during the first year 
of life than children born under other circumstances. It 
is also stated that nicotine is present in the mammary 
secretion of nursing women. This statement is entirely 
devoid of foundation. I have, when visiting one of the largej 
tobacco factories of Madrid, seen the women leave the^ 
workrooms at a certain hour to suckle their children, brought 
to be fed, and a healthier class of women, also stronger 
and better nourished babies, it would be impossible to find 
anywhere. The dangers to the health of tobacco and ciga 
makers from their employment have been (^aggerated. On 
the other hand, it is only proper to state that Galezowaki ' 
found visual troubles in persons engaged in the manufacture 
of tobacca Dc Schweinitz, an American ophthalmologist, 
reports the occurrence of amblyopia or loss of vision in 
persons who work in tobacco, but who do not use it in 
any form. He relates the case of a young woman whose 
symptoms diiappeared when she left the tobacco factory. 
Against these statements may be placed the opinion of 
Dr. Shears, who vLsited the works of Messrs. Cope Bros., and 
who on careful inquiry did not learn of one single instance 
of defective sight among the 1,300 men and women employed 
in the factory. The works at Pantin-Aubcrvillters, near 
■ " I>e% A.mUj'op. el AnuuniMS rcaique*/ p. 47, 1997, 



ORGANIC DUST, ETC. 



265 



I 



Pftfis, employ 800 persons, of whom 700 are women, but 
in none of these did I learn of any of the visual defects 
to which GatcKowski and De Schwdnitz have drav-n 
attention. 

France has recently introduced into the State factories a 
pension fund fur all workers. In these factories there is a 
nine-hours day : the men can make J fr. a day and the women 
S fr. 35 c. Men and women can work therein until the 
age of sixty-five. The State puts aside 4 per cent of the 
wages of the workers into the Caissc Nadonale for pensions 
from the first day the workers receive wages. After twenty- 
five years' service in the factory, or if the workers have been 
iavatidedt the women receive 400 fr. a year (^16) and the 
men 600 fr. (X24); but if both of these work until the age 
of sixty-five the pension is larger. 

As an illustration of the belief of the French authorities 
in the harmlcssncss of tobacco manufacture upon the health 
of the workers, I cannot do better than mention the following. 
In order to encourage female workers in the State tobacco 
factories to suckle their children, and thereby to reduce the 
high death-rate among infants, the French Government since 
August 5, 1905. offers certain monetary rewards. The 
women are allowed thirty days to recover from their confine- 
ment before returning to work, but on the presentation of a 
medical certificate that health and fitness have been re- 
gained, women may return to work twenty days after this 
event. During the three or four weeks the women are 
regarded as on the sick-list : they receive a gratuity of 30 to 
45 fr. if they arc working in the Department of the Seine and 
20 to 30 fr. if working in the provinces. To the mother who 
will suckle her infant and who has returned to work in the 
factory, opportunity is afforded of giving the child the breast 
at the factory, and the State at the same time gives her, in 
addition to her w^cs. at the end of every four months, an 
allowance of 10 fr. per month. At the tobacco works in 
Pantin- Aubervilliers only one-half of the women suckled their 
infants, and then only for a few weeks. I saw one healthy 
mother who had reared her infant on the breast for ten 
months, and she had received the allowance of 10 fr. per 




366 



DISEASES OF OCCUPATION 



month. When there are twins the State gives, if 
children are nourished at the breast, lo fr. per month fo£ 
each infant Certain formalities have to be obser\-ed, sue 
as the presentation monthly of the infants to the doctor o' 
the factory, who, after satisfying himself as lo the health and 
progress of the child, certifies accordingly. This action 
the part of the French Government towards the female 
workers in tobacco factories is the strongest proof that the 
manufacture uf tobacco and cigars is not an unhealthy occu- 
pation. Dr. Courtois-SuBit, who i3 the medical officer in 
charge of these factories, informs me that the work does no' 
affect menstruation, pregnancy, nor lactation. When 
woman is pregnant she receives for three months before her 
confinement, if in indifferent health, i fr. 40 c per day while 
off work, and after her confinement, if she is prevented work- 
ing on account of delicate health, she may for a period still 
rcceire the (ame allowance. Notwithstanding these beite-. 
volent offers on the part of the French Government, it 
becoming the fashion of female workers who have borne 
children not to suckle the infants, but to send them out to 
nursed. 

In the manufacture of snuff, the tobacco is allowed to' 
ferment. It requires three months for fermentation to take 
place; Whole stacks of tobacco are thus allowed to stand 
fermenting. These have to be broken down, shovelled 
away, and the hard tobacco ground into powder. The men 
engaged to do this complain that the work gives them a 
splitting headache and causes them to vomit. They look 
pale and unhealthy, the work is hot, and there is always 
a good deal of heavy vapour rising from the tobacco-bed in 
which the men are employed. When the tobacco is dry, 
there is a considerable quantity of dust, which the men say 
catches tbein in the throat and causes them in the morning 
to have brownish -black expectoration. 

In the department where the tobacco leaves are primarily 
steeped in water, the women employed occasionally sufTer 
from painful blisters on the hands. 



le 
1- 
n 




CHAPTER X 



MINING 



Coal' mining 

THE dangers to life from gas and explosions incurred by 
the miner in the getting of coal are dealt with else- 
where in this book. Here we arc concerned for the most 
part with coal-mtning as a dusty occupation. FifVy years 
ago coal-mineni' phthisis, or anthracosis, was a vrdl-known 
disease: to-day, thanks to the wcll-vcntilatcd condition of 
our coal-mines, the malady has remarkably diminished in 
Great Britain. If proof were required of the good effects of 
legislation in reducing occupational diseases, we have only 
Co turn to coal-mining and compare its pa-it with present 
statistics. There are certain occupations in which those who 
follow them arc all more or less picked and healthy men to 
commence with, but this cannot be said of mineni. Of all 
occupations in this country, none is more hereditary than that 
of coal mining. A lad goes into the mine because his father 
is working there and hi^ grandfather did so before him. 
Miners are therefore not a selected class of men. Although 
a large part of the working-day is spent underground, the 
occupation of the miner Is not an unhealthy one. Because 
miners' phthisis is largely a thing of the po-st, and was 
dependent upon faulty conditions, there is the opinion that 
the occupation of the coal-miner rather protects him from, 
than predisposes him to, pulmonary consumption. When 
pulmonary tubtrrculosis is caught by a miner, it is much 
more likely that the infection has been caught in the home 
or public'house than in the pit, where the ventilation is 
remarkably free and the air supplied particularly pure and 
abundant. In old colliery villages the houses of the miners 
are small, and the ceilings of the sIecping<rooms arc low, and 



268 



DISEASES OF OCCUPATiON 



there is frequently overcrowding; but in the newer mining 
villages many of these defects have been remedied, gardens 
ajc attached to the houses, and in these the men can work 
when not following their occupation. Better housing, the 
provision of purer drink ing- water, better food, good wages, 
greater railway facilities, and the establishment of rcading- 
and recreation -rooms have done much to improve the health 
of the mining classes, and to raise their tone socially and 
morally. As most of the collieries arc in the country, the air 
is good and the surroundings attractive enough. The daily 
walk of the miner to and from his work, although in many 
instances short, is in others sufficiently long to allow him 
to enjoy the walk, tired though he may be The com- 
parative freedom of the coal-miner from tuberculous phthisis 
is not confined to this country alone. According to a census 
of the United States, pulmonary consumption caused icfi 
per cent, of all deaths among miners and quarrymen, as against 
l6'3 per cent, for all occupied males, iu., the disease is nearly 
one-third less frequent among miners than among occupied 
males. In Great Britain, as Dr. John Tatbam has shown, 
the same thing has taken place. 

There arc 882,J45 coal-miners in Great Britain : of these 
709.339 work undei^round. Dr. John Tatham gives the 
following table to show the death-rates from all causes of 
miners in England and Wales at several ages compared 
with the corresponding rates of occupied males. 



I 



4 





>s- 


lao. 


ts 


ts. 


45- 


s» 


upmnh. 




wo. 


MO. 

•7 


IMk 


M*. 


100. 


twx 


MiaiDg iMlmtry •>• 


148 


I» 


7« 


« 


Ml 


■•17 


Cral-nincn 


IS« 


III 


K> 


77 


94 


119 


M3 


Darham and Nonhumbcrbiail 


IM 


III 


7^ 


M 


79 


97 


153 


Lancashire ~ 


101 


107 


(HI 


•M 


HO 


140 


150 


W»( Kidlns 

D«rby and NoU« 


"S 


93 


7* 


77 


H9 


136 


"38 


OS 


68 


bq 


W 


71 


9b 


lie 


StJtTiordshire 


« 


i09 


It} 


70 


<*•> 


ni 


■80 


Mcomodtb and Wales 


»7 


Ui 


llD 


97 


117 


140 


139 


IroBctone-uilner — — ._ 


'H 


<)0 


to 


bb 


m 


^ 


>44 


Tfn-tniner 


116 


»W 


III 


"1 


161 


>7« 


Lotd-mlncr 


118 


l»7 


130 


109 


It6 


183 


340 



MINING 



269 



At the ages from fifteen to twenty and twenty to twenty- 
five, as well as above flfty-five, miners die tn the •aggregate 
more rapidly than occupied males. In the intervening sfic^ 
their death-rate is lower. A large proportion of their high 
mortality is the result of "accident." This factor, as well as 
[the death-rate from phthisis, is brought out in the subjoined 
table, extracted fi^im one supplied by Dr. Tathain in 
" Dangerous Trades," p. 157. 





Accident. 


Phthlib. 


Resptnitorr 
Piimri 


Mining industry . .. 


MS 


109 


267 


Coal-miners 


141 


97 


169 


Durh&m and NonhumbeiUnd 


96 


94 


156 


Lancashire 


'55 


I03 


3^ 


West Riding 


"4 


H3 


388 


Derb)' and Notts 


«9 


69 


»59 


Staffordshire 


»55 


83 


J19 


Monmouth and Wales 


343 


107 


}4S 


Ironstonc-tnincrs... 


86 


90 


»<H 


Tin-miners 


48 


508 


377 


I«ad-miners 


43 


380 


3*5 



In some of the mining centres it will be obaerved that 

colliers not only suffer less from phthisis than occupied 
males, but that they also .tufTer unequally in different mining 
centres. Why this should be so, it is difficult to say. This 
remark applien not only to phthisis, but to the death-rate 
generally. While the death-rate from phthisis in miners i.t 
in many places low, that due to non-tuberculous atTcctions 
of the lungs is, comparatively speaking, high. The mortality 
of coal-miners from phthisis is at certain ages a little more 
than half of that to which other occupied males are subject, 
whereas tbeir mortality from respiratory diseases exceeds 
the same standard by 21 per cent. Whilst as a class miners 
enjoy considerable immunity from pulmonary consumption. 
yet the disease prevails.and is unequally distributed amongst 
them, as witnciss the high mortality from phthisis in the West 
Riding of Yorkshire — 123 — and in Monmouthshire — 107 — 




rji 



DISEASES OF OCCUPATION 



reduction in the death-rate rrom this disease within recent'' 
years. The improved health of the miner and his com- 
parative freedom from pulmonary tuberculosis are due to the 
better ventilation of the coal-mines, the air of which, as it 
passes onwards through the mine, becomes rid of bacteria 
and rcache^i the miner at his work in a purer state than the 
air which wc breathe in the streets of a large town. 

Nearly thirty years ago. when I became physician to the 
Newcastle Infirmary, it was not uncommon to have cases of 
coal-miners' phthisis in the wards. The patients used to 
bring up large quantities of " black spit," and after death 
the lungs were found to be black and solid. When the lungs 
were cut into and squeezed there came forth a dark fluid 
as black as ink. The lungs frequently contained cavities 
of various sizes and forms, and on microscopical examination 
the 6bro-connective tissue of the lung was found to be 
increased. The bronchial glands, too, on section, were 
equally black. So great has been the change which has 
come over the North of England coal- miners that I can 
safely say there has scarcely been a case of coal-miners' 
phthisis in the wards of the Newcastle Infirmary during 
the last ten years. The blackness of the lungs is due to 
the men inlialing fine coal dust and smoke from the lamps 
when working in con6ned spaces. Although a miner'^ lungs 
may contain large quantities of carbonaceous material, these 
organs are still capable of performing their respiratory 
function remarkably well, and on the whole the men have 
for a time good health. The pulmonary tissue Is wonderfully 
tolerant of the presence of coal dust and carbon particles, 
but a time comes when, the infiltration having exceeded 
the limits consistent with healthy function, aeration becomes , 
imperfect, the pulmonary tissue disintegrates and cavities i 
are formed, or, as is more probable, in consequence 
infection by the tubercle bacillus a tuberculous lesion 
established in the lungs. The disease is of slow develop- j 
ment At first the general health is gradually undetmmed, , 
then follow cough and carbonaceous expectoration, and 
on examining the chest there may be heard tubular breathing 
at some parts, deficient respiratory murmur at others. 



M1NMNG 



273 



muco<repitant rtles here and there, and exaggerated vocal 
re»?nance: 

As the opportunity may not recur, I will here briefly 
refer to some of the other ailments coal-mincrs suffer from, 
and which arc included among the diseases for which com- 
pensation is aw.irdcd under the Workmen's Compensation 
Act. I refer, among other things, to what Ls called miners' 
" beat hand." As a consequence of using the pick and 
friction of the handle, the skin of the palm along the bases 
of the fingers of both hands, also the skin over the fleshy 
ball of the thumb and that on the outer side of the hand, 
becomes extremely hard and horny. In addition to the 
enormous thickening of the epithelial layers of the skin, there 
is inflammation ofthe subcutaneous connective tissue. Occa- 
sionally suppuration takes place in the deeper layers of 
the hard skin. The suppurating areas arc called " keens " by 
the miners, and for their cure incision by the knife is neces- 
sary. "Beat hand" is a painful affection and unfits the 
individual fur work for some time. 

A similar condition of things occurs on the knees and 
elbows, hence the terms " beat knee " and " beat elbow." 

Colliers frequently complain of backache, pain in the lower 
part of the spine, largely the result of the peculiar mode of 
sitting adopted by the men when working. " Miners' back " 
is a troublesome complaint to treat ; the symptoms are 
entirely subjective and unattended by physical signs. 

Another common complaint of coal-miners is dyspepsia. 
This is the result of the irregularity with which the men 
get their meals, owing to working .alternately every week 
on the day and early morning shift 

Miners' nystagmus, or a peculiar oscillatory condition and 
unsteadiness of the eyeballs, is lc»s frequently observed than 
formerly. It i.<i due primarily to fatigue of the elevator 
muscles of the eyeballs when the men are working in a 
constrained position in a dim light and arc looking upwards 
In an oblique direction. Occasionally this oscillation of the 
eyes is attended by headache and giddiness and by the 
dancing of objects before the eyes, so that the miner is unable 
to follow his employment Recovery is slow, and can only 
T 



MINING 



175 



Comparative Statistics or Fatal Accidents in the 
Coal-mines of Different Countries : Prussia, 
Great Britain, Belgium, and France.' 

r. per thousand workers. 



y«ar. 


Pruuia. 


Great Britain. 


Belgiuin. 


FUncc 


1891 


3-89 


«'SS 


1-41 


1-66 


1893 


3-91 


.48 


a-84 


OW 


'8m 


a-61 


'55 


112 


093 


<»M 


3**t 


I -61 


i-6a 


0-85 


1895 


a 54 


I +9 


»'35 


110 


1896 


a-58 


148 


114 


i 30 


1897 


'35 


>35 


105 


107 


189S 


3-86 


raS 


*'4» 


107 


1899 


a-ji 


'■25 . 


099 


'■33 


1900 


»»5 


i»9 


'■05 


1.42 


iSqi-iQoo 


1-47 


1-44 


f.W 


118 


1901 


2"34 


1 37 


I 17 


lit 


■9o> 


1-99 


I -15 


ro7 


109 


1903 


i-9a 


laS 


I 14 


I'oa 


t904 


{-80 


1-25 


095 


n>7 



II. PER MILLION TONS OF COAL. 



Year. 


Pnusia. 


Great BriUii). 


BdgiuiD. 


France 


1891-1900 


917 


S' 


8-oa 


S'7 


1901 


943 


4-6 


7 -08 


6-1 


190X 


8>5 


4 5 


6-38 


6-0 


1903 


7-58 


47 


6-69 


4"! 


1904 


?'5 


4*6 


S-65 


5*4 



GoM-tnining on the Rand and EUtwhtre 

In British mines individual cases of "gassing" occur 
among the men, due to the use of the higher explosives, but 

■ Prom Circular No. 5083 of L« Comit^ Central dcs Houillercs dc 
Fnacc, stt Mars, igo6. 



276 



DISEASES OF OCCUPATION 



they are few and far between compared with those 
African mines. During 1904-1905 there occurred in the Rand 
mines 30 accidents from this cause. There were 40 deaths, 
9 of white men and 31 of natives ; 24 persons were seriously 
injured. Most of the accidents were traceable to the men 
returning to work in a particular part of the mine too soon 
after the bla^tiof; ; some of them were due to carelessness Jn I 
the handling of cartridges, while in olbcT instances the fumes | 
given oAf from the explosives travelled to other parts of the 
mine, even to different levels, and produced seriou<! symptora^M 
in the mcti who were working there. Drs^ Donald Macaulas^^ 
and L. G. Irvine state that, of the 40 deaths, i? were caused 
by nilrous fumes, and in one-half of these the diagnosis wa^H 
confirmed by post-mortem examination. 1 1 is cliaracteristiJ^ 
of poisoning by nitrous fumes that no symptoms may arise 
and no pain or discomfort be felt for a time, ami yet within 
12 to 18 hours after exposure to the fumes from the 
explosives people may die from acute ha:morrhagtc cedema 
of the lungs. In mines where dynamite, gch'gnitc, and nitro- 
f explosive compounds are used, and where the cartridge bums 
rather than explodes, the gas evolved may be both nttrc^fen 
oxide (NO) and carbon monoxide (CO), so that some of the 
symptoms may be due to the person having inhaled both of 
these gases. In a perfect explosion there should be, 
retically speaking, nothing but carbon dioxide, but even when 
the explosion is complete other gases may be liberated. 
Nitrogen oxide combines readily with oxygen. It 19 this 
affinity for oxygen that renders the study of its physiological 
actiuii difficult When Sir Humphry Davy tried to breat 
the gas he experienced a burning sensation in his throat and 
sense of constriction of his glottis, Nysten. after injecting 
nitrogen oxide into the veins of a dog, found that the ani 
died with a rapidity proportional to the quantity of 
Injected, and that death was preceded by obstinate cough, 
difficult breathing, small pulse, and signs of chilliness. 
Nitrogen oxide, by absorbing the oxygen of the blood, causes 
death by asphyxia, 

Peroxide of nitrogen (NOa) is formed when NO unites with 
O. In its free state the gas is reddish brown, is an 



oth of^j 
theofl 





MINING 



177 



oxidising aficnt, and is dis^reeable to breathe. The gas 
recalls the odour of chlorine, but while the eirccCs of chlorine 
are instantaneous and painful, and disappear without leaving 
any trace upon the or^nism when the inhalation has not 
been too protracted, it is otherwise with the fumes of nitrogen 
peroxide. During inspiration of nitrogen peroxide there is 
a sensation of painful burning in the throat, which teases 
when the fits of coughing have rejected the poison from the 
lungs. A few hours afterwards, when it would seem as if all 
symptoms Iwd ceased and all fear of possible complications 
had passed away, llie individual who has breathed the gas 
begins to complain of severe compression of the chest and of 
respiration being painful ; there is profuse foamy yellow 
expectoration, the face becomes pale, the temperature elevated, 
the pulse frequent and .small, and the patient succumbs with- 
out loss of his intellectual functions. After death the lungs 
are found to be gorged with dark liquid blood and are the 
seat of patchy hemorrhages, the bronchial tubes contain 
bloody foam, and the heart is filled with daric liquid blood. 
In some cases the stomach is distended by gas of an 
extremely acid nature, the intestines are red and the mucous 
membrane healthy. 

The inhalation of nitrogen fumes, especially nitrogen per- 
oxide (NOaX is extremely dangerous. Not only are the 
lungs oongested and the scat of haemorrhages, but the blood 
itself becomes brown, and gives with the spcctroscoi>e the 
band of acid luematin, situated a Uttle to the right of C, almost 
in the first third of the portion which separates C from D — 
which means the breaking U|} of the colouring matter of the 
blood into luematin and a proteid. 

I have dwelt at some length upon the effects of nitrogen 
oxide fumes, for " gassing " of the miners on the Kaiid has 
played an important part in the death-rate, owing to the 
extravagant use of nitro-cxplosives and the comparative 
absence of supervision of the men. So silently, too, have been 
the effects produced, that men have died without ever having 
been aware that they had been " gassed," owing to the fumes 
having travelled some distance in the mine. In the blind 
ends of drives, in winzes and rises, where there is no aerial 



3S2 



DISEASES OF OCCUPATION 



4 



sented by the Transvaal Medical Society to the Govcmmcn' 
Commission on miners' phthisis occur these word* : " Out 
of a !)eri&4 of 30 sputa from cases of disease of the langs 
of miners examined by 3 member of your Committee only 
two or three were found to contain tubercle bacilli," a cir- 
cumstance which *' leads us to conclude that while in some 
casesa true tuberculous phthisis may co-exist, or may be super- 
added, the conjunction is only seen in a minority of cases." 

In mining it ts not the coarse particles but the fine, im- 
palpable dust which is the source of danger, and which, in 
consequence of the arduous nature of the work in an over- 
heated atmosphere, is drawn by the miner into the recesses 
of his lungs owing to the dcei>er breaths he is obliged to take. 
On examining, as in one of my own experiments, tlic 
lungs of a dog that had breathed for several hours daily 
an atmospliere rendered dusly by finely-crushed Transvaal 
rock, the dust on microscopical examination could be 
seen lying in the finest ramifications of the lungs, and also 
in the interior of large cells, some of which were lying 
loose in the alveoli. These large cells are phagocytes, or 
microbe-eaters, and have the power of moving about in 
the lungs and of transporting both organic and inorganic 
particles. They tend to keep the lungs free from dust, 
and therefore play the part of scavengers, for while they 
may be expelled with the expectoration they may also pene- 
trate through the epithelial lining of the alveoli into the lym> 
phatic vessels, and pass with the lymph stream to the roots 
of the lungR, where they deposit the dust particles in the 
bronchial glands. The long black lines of pigment which 
are observed in the lungs after death mark the course by 
which dust particles have been carried. The walls of the 
alveoli become thickcn«i as the result of the irritant action j 
of the dust particles causing overgrowth of fibrous tissue — ^| 
hence the term fibrosis of the lungs. The rapidity with 
which the phagocytes remove the dust particles from the 
lungs is remarkable. After the exposure of an animal 
for a few hour^ to a sooty atmosphere the bronchial 
glands when examined a few days subsequently will be 
found to contain large quantities of carbon. It Is for this as 




MINING 



281 



gained a good hold upon the lungs, circumstances at any 
moment may arise to cause marked ingravc>cencc oi the 
physical signs and symptoms. One of the earliest tiigns 
exhibited by a Rand miner who is becoming "lunged" is 
shortness of breath. The patient who is the subject of 
miners' phthisis does not feel that he is really ill until 
he is almost beyond work, whereas in tuberculous phthisis 
the individual is often very ill long before there is 
extensive disease of the lungs, owing to the fact that 
the tubercle bacilli secrete toxins which poison the blood 
ami the nerve centres. In gold-miners' phthisis the loss 
of flesh and strength is so gradual that the miner con- 
tinues to follow his calling, for the cough is slight and 
there is little or no expectoration. By dep^es a sense of 
weakness impresses itself upon the patient, but it is the 
shortness of breath that obliges him to give up work. When 
the disease is fully established, it is observed, in addition 
to the dulncss in the chest on percussion, that the breath 
sounds arc coarse and tubular, but in the absence of 
accompanying bronchial catarrh moist rSlcs are not usually 
heard. There is often pain in the chest, owing to the 
presence of a limited pleurisy over the patch of 6brotic 
lung, which explains the adhesions that are found after 
death binding the lungs to the chest wall internally. There 
is, as a rule, neither the rise of temperature nor the evening 
sweating which arc present in tuberculous phthisis, and 
"blood spitting" is an extremely rare event So markedly 
absent is expectoration in uncomplicated cases that it is 
difficult to obtain sputum for bacteriological examination. 
In the early part of the illness, and sometimes throughout 
the whole of it, as in some of my own patients, the ex- 
pectoration is free from tubercle bacilli. In other instances, 
towards the end of life tubercle bacilli arc found in the 
sputum. This circumstance, the physical signs and symptoms, 
as well as the course of the disease, point to Rand miners' 
phthisis as being in the first instance a purely local aflection 
of the lungs, tlie result of irritation by dust, and without 
tubercle. When the disease becomes tuberculous it is in 
consequence of superadded infection. In the report pre- 



384 



DISEASES OF OCCUPATION 






ination of the men who had relumed to Newcastle and 
neighbourhood from South ArHct, Icada me Co express the 
ofMiiion that a shorter period of rock-drilUog than seven 
to nine years kills ofT most of the men, also that *• raising" 
and " driving " arc more dangerous than working in " stopcs," 
and that dry mines are more dangerous than wet mi 
There is a case recorded in the Re[x>rt of the Miners 
Phthisis Commission of two brothers, who, after working 
roclc-driU& for four years, " raising " alt the time, died ftom 
\atiR disease at the i^es of 38 and 30 respectively. 
Further evidence in support of the short life of rock- 
drillers is supplied by Or. L. G. Irvine, of Witwatersrand, 
who says, taking a limited period of years, that "on 
the Geidenhuis Deep Iwcnly-one men, having worked rock- 
drills for an average period of five years, died from chest 
disease at the average age of Jj'; years ; on the Geidenhuis 
Estate thirty-three men who had worked 6*9 years at rock- 
drills died at an average age of 34.'4; on the Jumpers Deep 
thirty-nine men who had worked rock-drills for 6'S years 
died at the average age of 37 ; on the Crown Reef we 
got the names of thirty-two men who had worked rock- 
drilU for 8'8 years, and who died at the average age of 
32 years. . . . Later on we got from the Crown Deep a 
list of forty-nine men who had worked rock-drills on an 
average for six years, and died at the average age of 
36-6." The shortest time on record of death from miners' 
phthisis after working rock-drills is three years. What has 
impressed me particularly in r<^ard to Kand miners' phthisis 
is that while the men knew what a dangerous occupation 
gold-mining was, chey still went on with the work, uncon- 
scious that their own lung^i were becoming impregnated witb; 
du»t. 

The miners on the Kand are paid for piece-work ; they ai 
impatient, and as lliey prefer to run risks, some 
may say that the men arc not altogether free from bl 
They rush back too soon after blasting to recommence work 
in the particular part of the mine, the air of which contains a 
slight excess of COa when the explosion has been complcti 
and always a large quantity of dust They neither allc 



MINING 



J85 






:o clear away nor the dust to settle. The men 
work in the mine 9 to 94 hours per day. Some patients 
have told mc that they had frequently worked 1 1 houni 
per day. The nnen do not leave the mine for food, except 
at a few mines north of the Rand, where the men who are 
orking machines, and arc not in charge of the " boys," 
come up for dinner at midday. Many of these men rush to 
the boarding-house and stt down to meals without washing 
their hands. They wash afterwards. As they can make £$0 
to £60 a month, they make haste to be rich, and to accom- 
pibh this they despise all the laws of hygiene. The white 
men know qLite well the danger they are running, but 
many of them arc indifferent to their fate. 

While comparatively easy to obtain statistics relating to 
Rand miners' phthisis among white men, it has been difficult 
until lately to know how the disease has affected the 
Kaffirs, since many of them on becoming ill return to 
their kraals, where they die often unknown to and unheeded 
by the employers. There is one circumstance which ought 
to diminish the liability of the "boy-s" to the malady, and 
that is that the KafBrs do not follow the occupation with 
the same constancy or as long as the white men. Once 
they have made a little money they return to their 
homes, but if perchance they have become the subjects of 
dust lung disease and have had grafted on to it tubercu- 
losis, they absent themselves from work and disseminate 
tuberculous di.4ea5c among their families in the kraal. 

It was not until October, 1902, that statistics were kept 
of native labourers. The mortality of natives working in 
the mines is high, tn a return presented by Dr. C. L. 
Sansom to the House of Commons on native mortality at 
the Kand mines for six months from October I, 1902. to 
March 31, 1903, of 70.23S employed 1476 died, the death- 
rate being 4203 per I,O00. The percentage of deaths from 
pulmonary disease alone equalled 43-$, or almost one-half 
of the total number. It is sUted that " pulmonary diseases 
amongst natives working in the mines are partly due to 
carelessness and ignorance of the native, who does not realise 
that whilst lie h living and working in a colder climate and a 




286 



DISEASES OF OCCUPATION 



higher altitude than he is accustomed to, he should take some 
ordinary common-sense precaution against getting sudden 
chills when heated by exertion, p^trtly due also to working 
in a diist-laden atmosphere and general living conditions 
in compounds." Two diseases at this date were responsible 
for the high death-rate, which in the latter half of 1903 rose 
to 80-36 per t.ooo, viz., pneumonia and phthisis, but enteric 
rcvcr, dysentery, diarrhoea, and scurvy also contributed. 
Since 1904, although'themortality has been greatly reduced, iti 
is Btitl too high. The death-rate is not equal in its incidence 
upon the natives. Those drawn from certain territories suffer j 
more from sickness and have a higher death-rate than others, j 
Of the natives who died, 45'a per cent, died within one 
month after altolmcnt to the mines. After this period the 
mortality shows a steady decline; the "boys" apparently 
become acclimatised to the work. The character of the 
work, too, is of importance. Eighty-five per cent, of the 
deaths occurred among underground boys" and 15 per 
cent among those working on the surface. It was hoped 
the provision of "change" and bath houses, drinks of hot 
coffee on coming out of the mine, and the di.itribution of warm I 
clothing would do much to diminish this high death-rate. 
Since, too, the decp-lcvcl mines showed a higher mortality 
than the outcrop mines, much was expected from better 
ventilation and keeping the temperature of the mines down 
to 75" and Hcf K. The normal temperature of the human 
body is gS'j^ R The effect of muscular work in a warm 
medium is to raise the temperature of the body to io|o F.,J 
and while this may cause little inconvenience or discomfort, a| 
further rise of !■> may not only cause considerable discomfort,] 
but unfit a man for work. The human body has to get 
rid of the excess of heat principally by radiation andj 
evaporation. In a hot mine, say iCP to 90° F., saturated wit 
moisture, the loss of heat by radiation is very slow. There' 
arc several factors contributing to the heat of 3 rain^^ 
t^., the number of men working, use of lights and explosive 
the heat given off by the metals in the rock by oxidation,! 
also the temperature of the air driven in by compressioa,,^ 
which b yy F. for every i,ocx3 feet of descent 



MINING 



»»7 



Mr. Hagh F. Marriott* gives a series of investigations on 
the depths and temperatures of South African mines. The 
mines varied in depth from 497 to 3,916 feet, and the 
temperatures from eS'j" F. to Syz" F. In order to measure 
the temjierature and secure as equable results as possible, a 
five-foot hand-drill bole was made in the rock near the floor 
and filled with water, the mouth of which, after being plugged 
with clay, was left untouched for 24 hour<; or more. 
Although the proportionate increase of temperature with 
depth varies considerably in dillerent localities, still the 
increase is always in direct proportion to the deptK In the 
Witwatersrand Goldfields the mean rate of increase was 
found to be a rise of i" F. for each 208 feet increase in depth, 
Or 0'48'» F. increase for loo feet depth. Starting, therefore, 
from the mean temperature of 1,000 feet depth as equivalent 
to 68750 F., Marriott gives the following : — 



IhgncifUir* 
68-75 

•• 7355 

78-35 

83*15 

8;-95 

9<'75 

97'55 

»o»"35 

The natural ventilation of the mines decreases the rock 
temperatures in the vicinity of the workings from y> F. to 
ICP F. Work in high- temperature mines is exhausting. A 
miner can cool himself by removing the greater part of his 
clothing when the temperature of his own body rises, but 
when the temperature of his enWronment rises to 100° F. 
and the air is saturated with moisture, it is impossible for 
him to do hard work for any length of time. I have not had 
any personal experience of the Rand mines, but I have 

' " A Record of an Invc«li);ation of Karth Tcmpctaturc* on the Wit- 
walcnrand Goldfields and their Relation to Deep Level Mining in 
lh« Localitj'.' Institute of Mimng and Melallurggr, London, March 15, 
1906. 



288 



DISEASES OF OCCUPATION 



incidentally seen the effects of high temperatures upon 
men who work in the Hungarian mines at Sopron-nrcnnbeig, 
whither I went to study the question of ankytostoffliasis. 
Here the temperatures are high. The men work practically 
without any clothing. The day's work is eight hours, but 
the men can only work ibur hours. Owing to the high tem 
perature the men are obliged to rest and to come out of the 
working into the main ways for air. As a consequence of 
working in high temperatures the Sopron miners seemed to 
me to be prematurely old, and a.s a result of their profuse 
perspiration the men were all thin and of spare body, and a 
large number of them suffered from functional and urgant 
diseaiC of the heart The effects of working in high-tem- 
poature mines are throbbing of the head, increased frequency 
of the pulse, discomfort in breathing, and physical exhaustion. 
On the Rand, as already stated, the miners at the end of their 
shift, when fatigued and perspiring, are rapidly lifted from 
great depths to the surface, where the temperature is con- 
siderably lower, a process that cannot but be attended 
risks to health from sudden chilling of the body. 

In the Transvaal Native Affairs Department Annual 
Report for the year ending June 30, 1906, it is stated that 
the recommendation of "change houses" at the shaft heads 
and the provision of hot coffee for the native labourers has 
been largely adopted, also that shelters has-e been erected to 
prevent exposure to the low temperatures, which have been 
regarded as the cause of chills and pneumonia. Much of the 
high death-rate was no doubt the result of the insufficient 
care exercised by recruiters in the selection and allotment 
of natives, many uf whom were physically unfit for the mtn 
From July. 1904, to December, 1905 — 

The toul dea.th-rau: among natives in mines was 45*5 per 1,000 
The death-rate among natives from tropical areas 

was Ii7'i per 1,000 j 

The death-rate amor^ nalives from Britnb Central 

Africa was 154*5 per i.oeoj 






Ml- 



■HP 




On December 31, 1905, there were employed in mines andj 
in all the labour districts of the Colony — 



MINING 



289 



Natives (exclusive of those recruited from tropical areas) ... 

Natives recruited from tropical areas 

Chinese 



84,167 
•0.570 
47.*»7 



Since then much has been done to reduce the death-rate 
[among natives by improving the recruiting organisation and 
1 by making better arrangements for the transit of the natives 
to the goldficlds, also by improving the conditions of life at 
the mines. The reduction in the rate of mortality amongst 
natives employed on mines and works has been steadily 
maintained. During 1905 the total death-rate 

From disease was 40'3per t,ooo 

, Amongst n&tivca recruited from tropical areas was 995 per 1,000 

(The term "tropical areas" comprises for the purpose of 
mortality statistics the following areas of labour supply : 
British Central Africa, Khodesia, Quilimane, Mozambique, 
and Oamaraland.) There is the greatest disparity in the 
relative ratet of mortality amongst natives from these areas 
and those recruited from non-tropical areas, as shown in the 
foltowing analysis of mortality : — 



Noo-Tropical 



Tropical 







Dath-Rate 


Rccniiting Ar««. 




per 1.000 p4. 


Orange River Colony ... 




... 13-9 






... 14*9 


Swaziland 




... 16-8 


Cape Colony 




19-8 


Ka« Coast 




... 35-8 






••- 35-« 


Transvaal 




je-o 


Bdsuioland 




... ♦51 


[ Moiainlnque 




... 65-8 


iQailinuae 




... 7.-6 


Rhodesia 




... 79'8 






... 113-8 


British Central Africa .- 




... 166-3 



290 



DISEASES OF OCCUPATION 



Whca these statistics are compared with those of previous 
years there is observed a marked reduction in the rate of 
mortality among natives from tropical areas, but there is a 
fnarkL>d increase among those from Basutolaiid. It is note- 
worthy, too, that the dcath-iatc varies in the dtfTcrcnt mines ; 
in the Premier Diamond Mine, in which a targe number of 
Basutos arc employed, the death-rate was 103*1 per tfioa, 
whereas the mortality rate of those employed elsewhere was 
only 27'5 per ifioo. The death returns were classified under 
coal, gold, and diamond mines. 

During 1905-6 the mortality on coal-mines was unusually 
tugh, viz., 6i'24 per 1,000, as against 44'6 during the previous 
year. On deep level goldmines the death-rate was 5924 per 
1,000 ; the death-rate on diamond mines was 56*63, and on 
outcrop mines and surface works 39*42 and 27*69 respectively 
per 1,000. In analysing the mortality rate it is noticed that 
respiratory diseases, of which pneumonia and phthisis have 
been respectively responsible for 31*6 and 144 per cenL, have 
accounted for 51-3 per cent, of the total deaths — the mor- 
tality rate from pneumonia showing a slight decrease and the 
death-rate from phthisis an increase by 52 per cent The 
death-rate from accidents was 5*64 per 1,000 per annum, 
or 12*S per cent of the total mortality. Through the kind- 
ness and courtesy of the Earl of Elgin I am able to supply 
recent statistics bearing upon this subject from a comparative 
point of view : — 



4 



COMrUA)l1« SiaTUMMT OF IKMIU-Cn UKWOCr KAnVB EMPUmtD ON Uwai AMO 

JUKun, tvA «m tm- 



UmDi. 



|«BKJ 



KaoI NaUvo 



Wt,«J0 IIIJ»« 



IMmim. D- 






Ko-M 
DcaliH 

rJOTD 

AoddanL 



DeMlMale 

DA Iram 
XcdArol. 



t«cft 



16 Liu 






TRttlBa. 

at 
DiMlM. 






Total 
pccuaa 






MINING 



391 



A)UtV«M 


tw 




1% 


TnutmkU. 




UoRth ^ 


no* 


StptrmtMr, Oclobv. 


NOTQtibcV, 


Decern b((, 


fmiurr. 


Pctnwr. 


PopaUtflcMi_ 


44.SS9 


♦M»7 *«o» 


«,*^ 


<T."7 


4J.>I7 


4MSS 


dncoT 
DoU. 


No 


IIa.Ic 

t,au 


No. 


RMt 
(JlOB 


RlU 
P" 

1;BM 
PJ- 


Na 


RXc 
pw 

pa. 


No. 


pw 
PJ- 


No. 


Rate 

P« 
i.oaa 


Kct 


WOO 
P*. 


PbltiUM ... 
PautDxmlii 
TabcKuloaU 
AMUedti ... 


S 

t 

«J 


I'M 


S 

1 
1 

«4 


"Si 
(rti 


• 

J 




7 

1 

M 


O'JB 
S«4 


3 
4 

1 

ts 


t-09 

a* 


» 




1 

« 
5 

H 




AUCmts.., 


]««« 


er 


•t«7 


T» 


■Ml 


1^91 


73 


'»a 


«l H7" 


T» 


1*17 



At the time of writing further statistical tables have not 
been published, but through the courtesy of the Colonial 
Office [ am able to supply ^gures for comparison of the two 
last months of the year 1906 with the two first months 
of 1907:— 

Chimbss Mortality Rats. Novevsek and Dbcbmbxk, 1906, 

JANWABY AXD FssaDARr. 1907- 





.706. 


1907. 




KcVBnbcr- 


Deccnsber. 


)*nu*ry. 


Ccbnuf)'- 


Ifmnbcr tmti\ojtd 


aoH 


5Mig 


SJ.KM 


51.7)> 




Xo.of 
Deathm. 


Rite 
P» 

I"- 


Mo.!* 

Dmtlu. 


Rue 

1,000 

JUl. 


Mo, of 
DeMh*. 


K)IC 

P« 

I.ons 

*•■■ 


lt«.al 


tpeo 
p»- 


Pttthias 


4 


0-91 


4 


o'90 


6 


»34 


3 


«r6f 


PDCumonLi ... .•• 


2 


V4i 


I 


0-13 


4 


089 


4 


0-89 


Tubefcvlotis 


4 


a'{)i 


S 


114 


i 


0-67 


' 


0-22 


Acddtat 


30 


679 


31 


476 


19 


£•46 


(9 


4'»4 


TflUl Deaths from mil 
Cum* 


8s 


18-56 


58 


I3IS 


s> 


tS-aS 


60 


'3- 39 



aga 



DISEASES OF OCXIUPATION 



I have not included in the Chinese mortalit>' tnhles the 
number of deaths from homicide, suicide, and the opium 
habit In comparing thcmortality returns of native labouren 
and Chinese one is struck by the fewer deaths from phthisis 
and accident among the Chinese. At the time of writing no 
case of miners' phthisis has been recorded among the Chinese, 
but this is only to be expected, for the work in mines has 
to be carried on a few yean before the disease develops. 
There is not the least doubt that within the next five or six 
years many Chinese, after their return home, will die of 
pulmonary disease, the result of the inhalation of the rock- 
dust of the Transvaal mines. 

When the history of the dev«lop<nent of the South African 
goldfields comes to be written, posterity is sure to pass severe 
strictures, not altt^cther unmerited from a medical point of 
view, upon the labour conditions that prevailed, and were 
allowed to continue so long unheeded. The race for wealth 
has alike blinded employers and employed to the lives that 
were at stake. There has been a disregard for human Hfc 
not creditable to those in chaige. Emploj-ers can take 
care of themselves, and the employed while men ought to 
have taken greater care of themselves, for most of them knew 
the risks to health they were running; but as regards the 
native labourers, who were ignorant of the dangers, it cannot 
be said there was the thoughtful and sympathetic care 
extended to them there might have been. The large 
number of deaths from accidents in the Transvaal gold- 
mines has been appalling. Since such a condition of things 
would not have been allowed to go on at home, it is more 
than probable that many of the accidents could have been 
prevented by spending more money on plant and by bring- 
ing to bear upon the mining authorities the expression of a 
healthy local public opinion through an unbiassed press and 
through greater publicity of Coroners' courts. The high 
wages paid to miners on the Rand is of itself proof of the 
dangerous nature of the employment, and yet, high as the 
wages have been, they never seemed to attract for any length 
of time the natives to the mines, 

The one disease to which in tliese pages attention has been 



^ 



MINING 



293 



^fedally directed is miners' phthisis. Attempts have been 
made to minimise tlie relation of the lung disease to the dusty 
nature of the occupation by assigning to the dust-storms that 
sweep over Johannesburg some part in the production of the 
maiady. March to November are dry months in the Trans- 
vaal. In July there arc frequently great dust-storms, which 
are attended by variations of temperature on the surface, and 
yet the people of Johannesburg do not suflfer from lung 
disease due to dust. 

Although no importance can be attached to thiis theory of 
" dust-storms " at Johannesburg, it is another question as to 
whether there may not be something spcciric in the dust of 
the Transvaal rock to explain the prevalence of Rand miners 
phthisic On this point the experience of Dr. R. H. Brcm- 
ridge, who is on the medical staff of the Kolar goldfield in 
India, is extremely valuable. In the Kolar goldmines there 
are 40,000 coolies employed ; the rock is hard. Dr. Brcm 
ridge went to India expecting to meet with cases of miners' 
phthisis, but he failed to find evidence of the disease except 
in men who had come from the Transvaal. Although no pre- 
cautions are taken in the Kolar mines to throw water on the 
surface to diminish the du.st after the use of explosives, and 
the men work hard, yet Dr. Brcmridge finds that the miners, 
native and white men, keep good health. He attributes the 
freedom from miners' phthisis partly to the fact that in India 
the men work eight-hour shifts, take more leisure, and arc not 
so eager to make a fortune as the miners In the Transvaal. 
There is plenty of dust in the Kolar mines; it is a hard quartz 
rock that is blasted, and without such precautions as the 
spraying of water. It would seem, therefore, as if there might 
be something in the character of the dust itself to explain, 
on the one hand, the prevalence of miners' phthisis in the 
Transvaal and, on the other, its marked absence in India, 
where no special precautions are taken to allay dust. Hard 
and angular as are the particles of all forms of quartz rock- 
dust, it would appear as if in the development of the malady 
there is something over and above mere mechanical irrita- 
tion of the lung tissue to explain why chronic inflammatory 
changes once induced run in some in&canccs a more rapid 




39^ 



DISEASES OF OCCUPATION 




course than in others and pave the way more readily for 
tuberculous infection. Although miners' phthisis on the 
Kolar gold5eld is remarkable rsther for its absence than its 
presence, it is not so with other forms of lung disease. 
Dt. Bremridgc finds that a large percentage of the miners 
die from pneumonia, due not so much to dust as to the fact 
that the men, after having worked hard for dght hours, are 
obliged to climb ladders to the height of 2,000 feet in a state 
of fatigue and when perspiring, and thus become chilled. 
The proof that this has had much to do with the prevalence 
of pneumonia has been demonstrated by the fact that since 
a skip, whereby coolies can ride to the irurface, has been 
introduced into one of the mines from which the largest 
number of cases of pneumonia came, the number of cases 
of acute lung di»!a!« has considerably diminished. 

Further support to the theory that certain forms of rock- 
dust are more liable than others to cause, if not miners' 
phtht&is, certainly symptoms of ill-health, is given by Mr. 
R. J. Watkin,* who had been for several years foreman of a 
sampling mill in Queensland, Australia. The work in the 
mine was dry and dusty. He found that he almost invariably 
lost the services for sc%'eral days of the four men who were 
working on the bottom floor. The ores that proved to be 
most dangerous were the sulphide ores; these contained, 
roughly speaking, 35 to 40 per cent of silica, 20 per cent 
pyrites, 15 j^er cent of zinc-blende, 3 to 4 per cent of copper 
and lead. The miners attributed the illness to the presence 
of lead, but the quantity of this metal was small and it was in 
an unoxidiiKd form, so that he could not accept this theory. 
Yet whenever this particular kind of ore was sampled the 
men became ill, and remained thus often for many days. I 
is more than probable that in these cases gases played an im- 
portant part in the development of symptoms. Shortly after 
the South African War miners on the Rand were encouraged 
to wear " respirators," but they could not work in them. So 
great is the dust in the mines that, as regards the Kaffirs, 
^eir upper lip and parts immediately adjacent to the nostrils 

• *' D1«CDS90D oo rrevention of Miners' f'hlhbis." Uininf; Institute, 
London, Hay 19, 1904. 



icr ^ 

e 

[t 

f 



MINING 



*95 



often appear greyish-whltc, as if powdered. This rime-like 
appearance stands out in contrast with their dark skin. 

In the mines the temperatures are high, and as the Kaffirs 
work practically naked, they simply throw a blanket round 
themselves on going from the mines to the compounds. The 
natives arc careless in regard to falls of temperature, and are, 
therefore, much to blame for the chills that follow exposure 
to cold. The compounda arc good ; the natives are better 
fed and better lodged in them than m their straw-thatched 
kraals, with small doorway closed at night, and in which 
a fire is lit without any provision made for the smoke to 
escape. The native labourer is a poor specimen of mankind. 
His physique is bad, and he does not stand illness well. 
Within r(.-cent years employers have introduced many im- 
provements. If mine-owncr.s would give further consideration 
to the hygienic conditions of labour in the mines, bestow a 
little more personal attention upon both the white and black 
men employed, sec that water-spraying is used with every 
rock-drill, spend more money on machinery, and keep it in 
proper condition, and would take such steps as to maintain 
the safe working of their cages, many lives would be saved 
that are otherwise imperilled, the risk of miners' phthisis 
would be reduced, and employers would cam — although not 
always expressed — the gratitude of countless workers. 



Australian Mines: Rt»digo 

A carefully prepared report upon the health of the miners 
employed in the quartz mines of Bcndigo, by Dr. Walter 
Summons. ha« been issued by the Trustees of the Edward 
Wilson Estate, Melbourne, 1906. In determining the extent 
to which phthisis and respiratory diseases arc present amongst 
the Bendigo miners the death rcgi.stcrs have been perused for 
the last thirty years, as prior to 1875 machine rock-drills 
were hardly in use. Since 1875 the number of deaths from 
pulmonary disease has much increased. At present there are 
3,650 quartz miners employed at Bcndigo, but in the year 
1S99 there were 3,9ga The following tabic supplies .statistical 
information as to the deaths of miners at Bcndigo : — 



296 



DISEASES OF OCCUPATION 



AmtDAL Dumt AiiOMC«r BsKDieo Mimbus, DrreRUiXBb ix 


FiVR-VUUt 


PsxioDs, AND Estimated as pkk Ten Troumnd Uvum at All Acss. 


Twr. 


Mln*n' 
(Tvbtt. 


Cfaratilc 
Broil* 
(bitu. 


Acute 


TOM 

DtMlM*. 


FaUl 

MlnlM 

AcgMbA 


AUctba- 
Cww*. 


TeUl 
beallu. 


isiis; 


48-S 
5fr9 


»t> 
131 


JO'S 

17-0 


8ro 


3a« 


74'3 
70-6 


100-4 
ato'S 


l885-«9 


Hov 


39-3 


3a« 


'«r9 


31J 


111-5 


HJ9t>^ 


84<> 


513 


■6-9 


»i« 


»8-4 


t»-3 


J84-S 


1S95-TO 


103'4 
IOO-0 


37 4 


105-4 


»I-9 


130^4 


3i?7 


1900-04 


JJ'O 


3IJ 


1453 


147 


S^5 


2563 


lUOS-o&IJ) 


iigft 


34* 


'"■4 


I9i'6 


9'J 


370^0 



Since 1880 there has been a marked increase in the number 
of deaths from respiratory diseases, especially from miners' 
phthisis. The total deaths from lung diseases have risen from 
77'0 to ipi-C per lOjOOO. and this is largely accounted for by 
the increase in those from tuberculous diseases, which were 
48*5 in the lirst period and 12^-6 in 1903 — an increase 
out of all proportion to the annual mortality rate from 
consumption amongst other occupied males. 

Fatal mining accidents, on the other hand, have been 
becoming fewer and fewer, owing to the greater precautions 
taken to safeguard the life of the miner. The number of 
deaths of miners from tuberculosis is six times greater than 
that of adult males in Victoria generally. While the disease 
has been dirainJsliing among t)ie general population, it has 
been increasing among the miners, which is pn>tty strong 
proof of the unhealthy conditions under which the work in 
the Bendigo mines has been carried on. A la^e number of 
the men have died before reaching the prime of life. The 
average age at death is under Bfty— slightly higher than that 
observed on the Rand. 

The lung disease of the quartz miners at Hendtgo develops 
Insidiously, without there being at first any symptoms to 
attract attention, unless it be slight cough. Occasionally 
there are recurrent attacks of mild bronchitis, which by 
denuding the mucous membrane of the respiratory passages 
of its protective ciliated epithelium more readily allows of 
the entrance and absorption of particles of dust. As the 



MINING 



297 



general health remains for a time good the men continue 
to follow their employment. With recurrent attacks of 
bronchitis there occurs "black sjrft," or the expectoration 
becomes muco-purulcnt, which on bacteriological examination. 
although found to be teeming with staphylococci and putrc- 
ikctive organisms, is yet free from tubercle bacilli. Shortness 
of breath sooner or Uter show-s itself and is a distressing 
symptom, for it is often severe, and is out of all proportion to 
the amount of bronchitis that is present. There may be 
complaint of stitch-like pains in the chest, due to limited 
pleurisies. On examining the chest by percusdon, dulness is 
frequently detected at the base of the lungs. Along with 
Dr. Jackson of Bendtgo, Dr. Summons examined with the 
fluorescent screen three patients who were the subjects of 
advanced fibrosis of the lungs. The lungs in each instance 
showed abnormal shadows that were extremely irregular in 
distribution, dark lines being particularly noticeable in the 
situation of the interlobar septa. 

Men can work longer in the Bcndigo mines than on the 
Kand without becoming affected. The average number of 
years worked is 22. Most of the miners presented the deep 
sunburnt appearance of men in health, and yet the slightest 
exertion would be attended by great difficulty of breathing. 
Summons classifies miners' phthisis at fiendigo under two 
heads: (a) pure fibrosis of the lungs, non-tubcrcuIar in origin, 
a true silicosis ; (i) a mixed type, in which there has occurred 
a tuberculous infection of a 6brotic lung. Bendigo miners 

IBulTcring from dust disease of the lungs were found to have a 
normal resisting power to tuberculous infection, but when 
irvfection took plaoe their opsonic index became subnormal. 
Forty-seven per cent of the men suffering from miners' phthisis 
became tuberculous. The high death-rate from respiratory 
diseases of 204 per 10.000 miners calls for some improvement 
in the conditions of labour and attention to hygienic details 
in the home. Owing to the frequency with which tuberculosis 
becomes grafted upon a diseased lung which at first was non- 
tuberculous, also to the risk of a careless consumptive patient 
spreading infection in the home, the greatest care should be 
taken to disinfect the expectoration, for at Bendigo miners' 



^i 




398 



DISEASES OF CXX;UPATION 



wives have died from pulmoiury tuberculosis in lit 
numbers than other married females in Bendigoand VictoriL^ 
Once symptoms of pulmonary Bbrosis have shown tbctn- 
Hclves, the men ought to give up work in the mincf, and \y 
engaging in some agricultural occupation thus Cry to prolong 
life. It remains to be seen how far such a change of occvpa- 
tion will be followed by permanent good results. The mines 
should be well ventilated, so as to keep down dust and reduce 
temperatures, but as dust is the enemy most to be feared, no 
rock-drill should be used without a jet or spray of water kept 
playing in and around the hole when the drill is in operation. 



Ganistfr Mining 

Canister or calltard, a hard, close-grained siliceous stone 
obtained from under the coal 9cam, is found in Yorkshire, 
Durham, and Denbighshire. When crushed and ground intQ 
dust it is made into briclcs, which, owing to their great 
resistance to heat, arc used for lining Bessemer and steel 
converters in ironworks. The mortality rate of the men 
who are employed in ganistcr mining is high. The mincn 
suffer from lung disease in larger proportion than the men on 
the surface, but the grinders even still more, and for tlu& the 
inhalation of dust is responsible. Attention has been drawn 
to the high dcatb-rale of gantster miners living in the valley 
of the Don by Dr. C. L. Birmingham.* and subsequently l^ 
Dr. Kobcrtshaw in his reports as Medical OflScer of Health. 
Stockbridge. Canister is so hard that, as it cannot be 
obtained in quantity by the ordinary methods of mining, 
recourse has to be had to blasting it by means of dynamite. 
When brought to the surface of the mine it is taken to 
powerful grinding mills, where it is pulverised and made into 
bricks. The men who arc liable to gzuiister disease arc the 
miners, grinders, and brick makers. In thb form of pneumo- 
koniosts the lungs become converted into hard, almost solid 
material, composed for the most part of dense fibrous tissue, 
which unfits them for performing their function of aeration. 
As it Is stone dust or particles of silex that are inhaled, 
* fourmU s4 the SamUary ImilitmU, ^ril, 1900. p. 07. 




MINING 



^aSasc is known as silicosis. Both in the preparatory drilling 
^of the rock for blasting and after the use of explosives the 
Phtmosphere becomes charged with very line dust It is into 
" such an atmosphere that the miner enters afier firing ex- 
plosives. Hccannot prevent himself inhaling particles of dust 
These, becoming caught in his bronchial tubes and lungs, 
induce a reactive inflammation which ends in fibrosis. When 
the disease has gained a firm hoid the miner becomert anxmic 
and enfeebled in health. Gradually developing a cough and 
becoming the subject of difficulty of breathing, he is unable 
to undergo the physical exertion required of htm in his work, 
and is therefore at a comparatively early ^e obliged to 
relinquish his occupation. Dr. Birmingham supplies the 
ibllowing data: — 

During 1894 there were 33'86 deaths from ganister disease 

per 1,000 uroilcers 



r893 


1, 


2859 


1896 


II 


1714 


1897 


n 


«8-59 


1898 


n 


1429 



or an average annual death-rate of 22*29 per 1,000 workers. 
The mortality rates differ as between ganister miners, 
grinders, and brickmakers. For every 1,000 men employed 
in each group there die annually: 



Ganister miners ... 
„ gniiders 
H brickmukeni 



1798 

33'> 



The mortality of ganister grinders is gight times as great 
as among brickmakers and four times as great as among 
miners. Readers may well wonder how it is possible to find 
men willing to follow such an occupation as ganister grind- 
ing, with a death-rate of I79'3 per 1,000 employed. Owing 
to the arduous nature of the work it is difficult for the men 
to wear respirators, and although steam jets and sprinkling 
with water have been introduced to allay dust, the mortality 
from ganister disease still remains far too high. 



'■atJ-'H -* 



302 



DISEASES OF OCCUPATION 



Slate-mining iii not free from the risk of accidents. Durfnjr 
the nineteen years ending 1895 there were in the Merioneth- 
shire slatc-mincs [47 fatal accidents, in which 163 lives were 
lost, due mostly to falls of roof and side during the process 
of getting the slate. Roofs and sides of a slatc-minc that 
arc perfectly safe when left by the miners and r&ckm^n 
become less and less safe as time goes on. Air and moisture 
penetrate into the joints of the rock and loosen it, while the 
natural earth tremors and the quivering caused by blastii^ 
are not without their influence in weakening the supports. 
Only a small number of the accidents was traceable to the 
use of explosives. The average annual death-rate from 
accidents during the nineteen years mentioned above 
as follows : 



Per t,eoo persons employed underground 
,, „ above ground 

,1 ., above and below ground. 



; vras [ 



©■70 

»'94 



"The occupation of the Merionethshire slate^miner is moi 
risky than that of the average miner of the United Kingdom, 
but less hazardous than that of the South Wales and of the 
Cleveland miner." In the open slate quarries of Carnarvon- 
shire, t^., those of Penrhyn and Dinorwic, there are com- 
paratively few accidents: 076 and 071 per 1,000 persons 
employed respectively. Dr. Richard Jones, of Blaenau 
Festiniog, who has had large experience of slate-miners 
and their maladies, says that the Festitiiog quarrymen are 
less liable to phthisis than the non-quarrj'mcn in the district, 
but that the deitth>rate from phthisis is higher among those 
engaged in the slate mills than among the underground 
workers, the roikmen and miners. This, as might be 
expected, is partly the result of the dust created during the 
dressing of the slates. Festiniog quarrymen are especially 
prone to pneumonia and to diseases of the alimentary ca; 
There is a general agreement of medical opinion chat 
diseases from which slate-miners particularly suffer are 
(1) diseases of the respiratory organs, especially pneumonia; 
(3) rheumatism and its complirations ; and (3) indigestion. 



""7 




MINING 



303 



The cold, damp climate of the district, imperfect housing of 
the workers, and the undraincd character of the land con- 
tribute to the causation of rheumatism and dbcascs of the 
respiratory Cleans. Owing to the scarcity of houses several 
of the men live in "barracks^" These are frequently badly 
kept, are far from being sanitary, and are always over- 
crowded. The food of the Welsh slate-miner is poor — too 
little nitrogenous food is taken and too much stewed tea 
is drunk. It is interesting to note that the death-rate from 
phthisis is higher among the females in the district than in 
the miners, and that they die from pulmonary consumption 
at an earlier age than the miners — strong proof of the 
imperfect house accommodation. The mean age of females 
dying from phthisis is 3t*4 years, of quarrymcn 39Y>8, 
and non-quarrymen 35*6. In 1890 Dr. Richard Jones (bund 
that 55 per cent of the deaths from respiratory diseases were 
due to pneumonia, but the usual average is 36*4. The men 
who dress the slates in the mills are more liable to fibroid 
phthisis than the men who work underground : the latter, 
_^Dn the other hand, are more liable to pneumonia, probably 
Bthe result of chill and exposure on leaving the mines. Were 
it not for the fact that S>000 cubic feet of air-space per man 
is the average in the mills, as against the 250 cubic feet 
required by the Factory Law, fibroid phthisis would be 
probably more prevalent than it is. 

Dr. Lachlan Grant, of the Ballachulish Quarries, Giencoe, 
informs me that fibroid phthisis and pneumonia are seldom 
met with among the quarryroen there, also that pulmonary 
tuberculosis is more frequent among the women employed 
at home than among the men. All the slates are hand-cuL 
^^No machinery is used, not even hand-drills. The immunity 
^'enjoyed by the Ballachulish quarriers may be partly due to 
the fact that as all the work is done by hand less dust is 
raised. 

The subject of the maladies of slate-miners in France has 
been carefully studied by Dr. Sejournet,' of Revin, at the 
St Joseph slate-mines near Fumay, a small town with 5,280 

' " La Mnladie dcs Ardoiucrs : la SchistOM:," Reims, i9ua Itn- 
priffleric Uatot-Uiaine. 




3<H 



DISEASES OF OCCUPATION 



inhabitants, in the valley of the Mcusc: The five slate 
of the district gi^'e employment to 600 men — one half of 
whom work undei^round, while the remainder are employed 
on the surface dressing the slates. Dynamite is made use of 
to dissever the rock. The miners inhale the dust and the 
fumes caused by the blasting. In some of the slate works 
the only mode of exit from the deep mines is by long 
ladders and steps ; in one mine, after a hard day's work 
of twelve honis, the men have to lifl themselves up ladders 
and stairs with 1.500 steps before they can emerge — a 
process attended by a considerable amount of fatigue as 
well as consuraptioQ of time. The rough cutting of slates 
is mostly done by hand. A cutter can make from 1,000 
to 1,200 slates per day. These are passed on to other 
nteii who by means of machinery give the required shape 
to the slate. Machine cutters can turn out 600 to ^00 slates 
per hour. The work is dusty, and during the whole of the 
working day the men are more or less inhaling dust. The 
French slatc-mincr has been represented »■> a man of short 
stature and bent, round-shouldered and almost hunchbacked 
in appearance, but at Fumay many of the slate-miners are 
men of good physique and they carry themselves straight 
Notwithstanding this, several of the slate workers are 
observed to walk slowly, their chest is frequently band- 
shaped and emphysematous, and although young and 
apparently in good health they arc short-winded com- 
pared with the men in the district who are following 
other occupations. Like the Welsh slate-miners, the diet 
of the French workmen is poor. Their food is mostly 
potatoes and cafiau tail, or soup and bread. Dr. Hamaide, 
of Fumay, who knows the slate-miners well, says that they 
begin to suffer from bronchitis between the ages of 35 and 
40 years, and that once this becomes Bxed and is followed 
by structural alterations in the lungs and brotKhi, the 
malady proves fatal in S to 10 years. The mean dun* 
tion of the life of the Fumay slate-miner is 48 years. 
Most of the miners die from pulmonary fibrosis, the result 
of the inhalation of dust Dr. liamaidc has seen (Den 
who are the subjects of slate-miners' phthisb expectorate 




MINING 



305 



* 



lents of hard, stony material tike schist, accompanied 
by prorusc bleeding from the lungs. Dr. Artidgc found a 
similar thing happen in the lung-afTected potters of Staf- 
fordshire. M. Ripert reproduced experimentally pnetimo- 
koniosis in the lungs of rats and guinea-pigs by slate dust. 
French writers divide the lung disease of the slate-miners 
into three stages: (1) the period of commencement, in which 
there are symptoms and signs of pulmonary emphysema 
with difficulty of breathing and dry cough ; (2) an indefinite 
period in which the emphysematous type of the disease may 
be attended by accessions of asthma, and which may allow 
the miner to live to the age of 60, or the disease becomes 
associated with congestive attacks that arc followed by 
pleuri-sy or pneumonia ; and (3) the terminal stage, in which 
the lung becomes hard and fibrotic, owing to the large 
amount of slate dust it contains. In 65 per cent of the 
cases no tubercle bacilli are found in the sputum — a cir- 
cumstance which points to the dust or^in of the malady. 



Sf0fifmas0ns' Phthisis 

The occupation of the stonemason and of the quarryman 
has for long been regarded as one in which a higher death- 
rate from lung disease occurs than in most occupations. The 
disease, which usually assumes a chronic character, is slow in 
its development and progress. As it is attended by the 
ordinary physical signs and symptoms obser\'ed in other 
forms of pncumokonioais, the malady calls for no special 
description other than this, that in contradistinction to 
miners' phthisis, which occurs in men who work underground, 
stonemasons' phthisis is met with in men who are working in 
the open air, a circumstance which becomes a strong argu- 
ment in favMur of the dust or^in of pnetimckontoses as 
against tlic bacillary. After a time the lung disease becomes 
tuberculous, hence the extraordinary fact of the death-rate 
from pulmonary tuberculosis among stonemasons and marble 
cutters, who arc following an outdoor occupation, being six 
tiroes that of bankers and brokers, who are leading an indoor 
life; This want of harmony between occupation and mortality 




MINING 



307 



In order to study millstone builders' phthisis I went to 
Fiert^-sous-Jouarre, in France, where the buhr-slonc is 
quarried, In France the millstone building is carried on 
exactly in the same manner as in England. Similar condi- 
tions prevail among the men, there is the same tendency for 
lung disease to develop, and, if anything^, the intemperate 
habits of the British millstone builders are surpassed by those 
of the Frenchmen. There were no old men working in the 
yards. Most of the men in the Ftcrt^ yards die before 
reaching the age of forty-five; the men, too, look old for 
their age. The Government inspector who accompanied roe 
stated that the men worked on Wednesday, Thursday, 
Friday, and Saturday, and drank on Sunday, Monday, and 
Tueiiday at least. This may have been an exa|^erated 
txposi of the failings of the men, who pleaded to me, as an 
excuse for tbcir excessive indulgence in alcohol that they 
suffered from an intolerable dryness in the throat created by 
inhalation of the dust As a similar complaint is made by 
all persons engaged in dusty occupations, it is not without 
some basis of foundation. In discussing with the doctor at 
Fiert^-sous-Jouarre the subject of diseases incidental to mill- 
stone builders, he alluded to the high mortality rate of the 
men from pulmonary phthisis at an early age, and confirmed 
all that has been said of the intemperate habits of the work- 
men. The wearing of respirators has been tried by the men, 
but they tend to restrict the freedom of breathing. A few of 
the more careful men make use of water-spraying while 
chiselling the stone, with tlie result that not only is the dust 
allayed but their health is better. 



Manufacture of Pottery 

The manufacture of pottery has for long been regarded as 
an unhealthy occupation. As far back as the days of Ramaz- 
zini ( i6;g}, the lung troubles of the potter had been recognised 
and described. With the terms " potters' rot " and "potters* 
asthma" the public arc quite familiar. It is this liability to 
lung disease on the one hand and to lead poisoning on the 
other that has placed pottery manufacture high up on the list 




MINING 



309 



I 



I 

1 



artificial removal of the dust. Amonj; the bnisfaers-off 
in Limoges there is a high death-rate from respiratory diseases 
and pulmonary consumption. Of /5 deaths registered as 
occurririf; in china-makers, 36 were due to phthisis, and of 
30 potters whom Dr, Raymondaud examined, 20 were suffer- 
ing from phthisis. Pulmonary phthisis is regarded as the 
principal disease affecting the workers in the Limoges 
potteries. Dr. Lemaistre, with whom I had the opportunity 
of discussing this subject, had analysed the air of the potteries, 
and he found that the dust in some of the workshops is com- 
posed of earthy particles, fragments of granite, 6int, particles 
of dried glaze from the ware, soot, and wood charcoal. The 
atmosphere in which the brushers-off, the finishers, and the 
porcelain makers generally work contained 64.0 million 
particles of dust per cubic metre of air, while several of the 
finishers, Ir., the persons whose work consists in removing 
the excess of the dried glaze on the ware, are often breathing 
an atmosphere containing 6S0 million particles of dust to the 
cubic metra This large number of dust particles in the air 
of the workrooms is one explanation of the frequency of 
bronchitis and pulmonary disease in pottery workers, and 
while these dust particles act mechanically they may, by 
making a breach in the epithelial lining of the smaller 
bronchial tubes and pulmonary alveoli, reduce local resistance 
to micro-organisms, and therefore pave the way for the 
entrance of the tubercle bacillus. The averi^re age at death 
of men from fibrcMd phthisis in the potteries of Limoges 
is 43, and of the female workers 38 years. In the 
Staffordshire potters Dr. Arlidge found that the mean 
age at death of male potters aged twenty years and upwards 
was 46'5, and that of non-potters 54. Bronchitis is met with 
among the male prcsscrs, who arc exposed to the dust of the 
clay, but in china scourers the severer types of pulmonary 
disease prevail. 

Much can be done by means of improved ventilation to 
diminish the evil. Open windows are not enough : fans and 
strong aspirating draughts must be provided. Scouring of 
china by hand over a grated trough into which the ground 
flint falls should be discontinued and done in semi-closed 




310 



DISE^ASES OF OCCUPATION 



ttoxes, with a strong downdraught on the ofT^iide of the 
workers, or by revolving brushes driven by machinery in 
semi-closed spaces similarly aspirated. As dust diseases 
of lungs develop insidiously and prepress slowly, it would be 
to the advantage of the workers tbemsclvcs if their cbcst 
*vas examined every few months by a doctor, for signs of. j 
commencing lung disease should be refjarded as disqualify- 
ing fur furthta' emp)o/meni in china scouring. 



Mixed Forms of Pneumokonioses. Slag Work 

Since men who are following a dusty occupation are 
frequently exposed to more than one particular kind of duet. 
so in Ihcir lungs after Heath there is found corroboration of 
the facL In colliers who work in bard coal there is occa- 
sionftlly found a mixture of coal-mincrs' phthisis and stone- 
miners' phthisis, anthracosis and .silicosis, in needle-grinders 
siderosis and silicosis and in pottery workers ^licosis and 
aluminosis. In the hings of an emery grinder who d!cd 
from chronic pneumonia Professor Lctullc found hard masses 
which, on chemical analysis, were composed of silica, alum, 
and ix:rox!de of iron. The »Iag which is left in the manu- 
facture of steel by the Gilchrist-Thomas method contains 
phosphate of lime, magnesia, iron, and silica, and when 
ground to a fine powder is sold for the purposes of manure. 
In my visits to the slag-crushing works in Middlesbrough and 
elsewhere, I have been struck by the large amount of dust 
that is givai off during the cru^ing of this refuse from the 
blast furnaces. If not wearing respirators the men cannot 
avoid inhaling the dust, and as a consequence several of 
them suffer from bronchitis and asthma, chronic cough, and 
difficulty of breathing. The men, too, arc liable to pneumonia. 
A few years ago there occurred an epidemic of pneumonia 
in Mitidlesbrough, the nature and origin of which, for a 
time, remained t^scure. As its ravages were particu- 
larly severe among men labouring at the blast furnaces 
and in the slag works, the inflammation of the lungs was 
at first believed to be in some way or other connected 
with the dusty occupations these men were following. Dr. 



4 




MINING 



311 



Ballard, of the Local Government Board, subsequently 
demonstrated that the pneumonia was of a specific type and 
was due to the consumption of tainted meat. Although tn 
this particular outbreak of pneumonia slag crushing was 
proved to be in no way responsible for the malady, in 
Germany st^ crushers have been found to be the subjects 
of respiratory diseases in larder proportions than men 
following other occupations in ironworks. 



MtiaUk Dust and Siderosis 

Only a few cases of siderosis have been reported. For 
what we know of the malady we an- indebted mostly to 
Zenker, Thcdiscascis met with in persons who work among 
the red oxide of iron, t^^ looking-glaiis makers, gold beaters. 
glass polishers, and in men who clean the surface of rolled 
iron plates by means of sand. In the men employed in this 
last occupation, the greyiah black dust which is found in 
the lungs and bronchial glands is the oxide of iron in the 
form of the magnetic oxide. Persons who arc suffering from 
»iderosis have the usual signs and symptoms of a pulmonary 
dust disease, with, in addition, the expectoration of reddish 
material due to the presence of iron. Zenker found on post- 
mortem examination that the pleural surface of the lung was 
studded with red patches, and that on section the lung 
substance exhibited a brij^ht brick-red appearance. Although 
there were cavities in the lungs there were no traces of 
tuberculosis. The brick-red appearance of the lung was 
chemically proved to be due to the red oxide of iron. 



:hj 



'ER XI 



DIStCASES DUE TO PAKASITES AND MICKO-ORGANI.SMS 



Ankylosiontiasis, Mintrs' Worm Disiast, Miners' Aiurmia, 
Hook-worm Disease or Uncinariasis 

TT was during the tunnelling of the St. Gothard in [89a 
for railway purposes that European nations first came 
to realise what a power for harm ankylostomiasis can be 
During one year when engineering operations were in 
progress at the St. Gothard, there were registered between 
October I, 1880, and September 30 following, 186 cases 
of anxmia in miners. The making of the tunnel was 
attended by a loss of life, human and equine, which was 
appalling. Many of the miners were seen to become pale, 
to suffer from shortness of breath on exertion, their feet 
to swell so that the men became unable to walk, and as the 
illness assumed endemic proportions and had not been 
observed previously to any extent in Europe, the malady, 
since it was thought to be the consequence of men working 
in tunnels, came to be called "roaladie dcs tonnelles." As 
pallor of the body was one of its most striking features, it 
was also known as "miners' anaemia." At first it was 
currently believed that owing to the Rreat lenjjth of the 
railway tunnel, upwards of nine miles, the conditions under 
which the work was carried on in the interior of the Alpine 
mountains were extremely unhealthy, and that the men 
succumbed to the combined influences of excessive heat, 
laborious work, bad food and ventilation, also to the effect 
of the sudden chilling of the surface of the body when 
the men, fatigued and perspiring at the end of their shiffc, 
emergecl from tlie warm tunnel into the biting cold air. The 

3ta 



PARASITES AND MICRO-ORGANISMS 313 



Gothard tunnel 



itted 



tions 



^JElDtilation of the 
been tlefective, so 
existed could not have been other than prejudicial to the 
health of the miners. It was rcscired to Dr. Fcrroncito, of 
Turin, to discover and point out the real cause of the malady. 
On making a post-mortem examination of the body of 
deceased miners, he found numerous small white threadlike 
worin^ in the upper part of the soutll intestine aiwi adherent 
to its lining membrane. When the parasite was examined 
microscopically, it was recognised as the worm described by 
Uubini, of Milan, in 1838, and further as the same parasite 
which affects the fellaheen of Egypt, causing Egyptian 
chlorosis, and the field labourer-i of India, Ceylon, Assam, 
South America, Australia, &c The malady was not there- 
fore, as was at first thought, a new disease. As far back as 
3450 years a^ there appears in a medical papyrus an accu- 
rate description of the symptoms exhibited by a person who 
is suffering from ankylostomiasis. In the United States of 
America the disease has been r<^arded as the result of mud 
or earth eating, especially among the poor white people and 
the negroes who live along the banks of tlie Roanoke River 
in North Carolina. It was also found years ago among the 
slaves of Loui-iiana, and attributed to the same cause. The 
Zoology Director of the United States Government, Df. 
C. W. Stiles, describes two species of the ankylostoma, the 
New World parasite and the Old World parasite — the latter 
so called because of its having been introduced into America 
by immigrants from Europe. The disease is spoken of by 
Stiles as "uncinartasb." He regards residence on a sandy 
soil as one of the conditions favourable to the development 
of the disease Many of the cases occur in agricultural 
labourers and in women and children. The women and 
children suffer more severely than the men. A large number 
of infected young pcrson.s become pot-bellied, like the Indian 
children who have been fed upon rice. 
Since ankylostomiasis affects field labourers who are 
'working in the glare of a warm sun equally as well as the 
lulian miners in the gloom of the St. Gothard, it is 
apparent that the disease must be due to other than 






DISEASES OF OCCUPATION 



aobCerraneaa aaaea, Perroodto settled tiie poiot so &r as 
B oodoented It was by tttaSmtg the kaomieigK 
toppoto bjF htni 2nd otben, uso ovii^ to 'p**"*** cw *"— ' 
of the mioen by the medical men, that the «n p nwi» woe 
able to make and cookpfete the ^mpioD Tcooel, wlikb 
is three nnei Wi^er tfaan the Sl Gotnaid, witlioat 
of anlcylostofniasis appearing am ong * the 

On the compfetioa oT the Sc GodMfd tBOnel there 
set free U^e oucnben of ItaBan iaiiief% «ba in order to 
abtain employment elsewbcre, tn^dled &7 and wide to tlic 
various minmg districts of Central Europe. A few yean 
a fte rw ar ds ankykstonuasb broke oat un e x pectedly in die 
ooal-bcaring districts o( Hnngary, Gcmiaiiy, and BclgioBi 
and u the disease ass ume d alarming proportioas it called 
ferth the united eflbrts of the mining aatfaorities and the 
medical profession to cope with the lavages of the eodeok. 
While thu was occurring on the Continent, considerable 
uneastneai was created in our own countr)- by the disoovay 
o( the disease among the tin-miners of Cornwall. Tbe 
mana^ of Ae Dolcoath mine bad observed that several of 
tbe minen were suflering from dcbilily, anxmia. and oidei M 
of the feet, and were unable to follow their occupatioa. He 
attributed the ill-health of Ae mises* to imperfect ventilation 
of the mine, but on mlcroaoopkal examination of tbe Ccces, tbe 
ova of the ankylostoma were found therein. Tbe malady 
had, therefore, niently gained an en/r/e into the tin-mines of 
Comwall : it was the same disease as that which proved 
90 destructive to the miners in Westphalia and Hui^ary. 

In order to study the subject of ankylostoouasis praettcaUy, 
I ratted tbe Dolcoath mine, where, through the kindness of 
the manager, Mr. Thomas, J had not only the opportunity 
of descending into the mine, but oF examining infected 
workmen. Subsequently, in company with Mr. Gelger, of 
Armstrong College, Newcastle, I proceeded to the infected 
coal-iielda in the valley of the Ruhr in Westphalia, and to 
those of SoprcMi-nrcnnberg, in Hungary. We entered the 
Wcstphaljan coal-fields by Bochum, for it is here that Dr. 
Tenholt li%-e*, who is in Germany the greatest authority on 
the miners' worm disease. Here, too, is established tbe 




PARASITES AND MICRaORGANISMS 3^5 



excellently equipped Knaffschaftrverein, or Miners' Institute, 

R which, while it is the official centre of the colliery proprietors 
■nd of the workmen, is also the seat of the medical adminis- 
tration and of mining education. 
I [t was in 1760 that men began to win the coal in this 
particular district of Germany, but it was not until 1S40 that 
the impetus was given to the coal industry which has made 
, Westphalia the prosperous Duchy it is to-day. So great was 
^^hc demand for coal a few years ago, that in one year there 
entered Westphalia twenty thousand miners. These men 
came from Posen in Prussia, from Poland, Huncary, and Italy. 
It is not known how ankylostomiasis was introduced into 
the valley of the Ruhr. Some authoritieii maintain that the 
disease was brought thither by infected Italian miners who 
had just quitted the St Gothard ; by others it is contended 
that the malady came from Hungary ; while others again 
blamed the men who had worked in the bnckflelds near 
j Cologne in the summer and in the mines in winter. Owing 
to the lai^ number of miners who entered Westphalia in 
one year, as already mentioned, and who were of various 
nationalities, it is impossible to say how ankylostomiasis 
originated in the German coaMiclds ; but while the origin of 
the di.sca.-ie is unknown, there is not the least doubt that the 
use of water sprays in the mines, compulsorily ordered by the 
Government owing to the fiery character of the coal-dust and 
the numerous explosions that had taken place attended with 
loss of life, materially contributed to the spread of the 
disease. Water-spraying became general in 1900. In the 
II Kuhr Valley, where most of the coal-mines are situated, the 
L number of cases of ankylostomiasis has been as follows : — 

1^^ The increaw in the number of cases of ankylostomiasis in 
the German mines after water spraying is more than a coin- 
cidenc& It became a serious matter in Westphalia from a 







&>a. 




Cud. 


1896 


... 


... 107 


1900 ... 


••• «7S 


i«9? 


<■• 


... IJ3 


1901 ... 


... 1,030 


1898 


... 


... 99 


t90> ... 


— '.355 




3i6 



DISEASES OF OCCUPATION 



Joe 1 



health and money point of view, to say nothing of the 
and economic questions which it raised. During the three 
years previous to my visit it cost the Miners' Union in its 
efforts to grapple with the disease upwards of £lOOfXXi. 
Nothing could exceed the excellent organisation and the 
hygienic methods adopted by Germany to get rid of the 
scouige. They are object lessons which this country, in the 
event of the disease becoming endemic, might follow. 

la July, 1903, the Royal Department of Mines ordered 
microscopical examination to be made of the excreta 
not less than 20 per cent of the underground miners living in 
the province of Dortmund It was found that of 188,730 
workmen employed, t7.i6i. or 9-1 per cent., were suffering 
from ankylostomiasis. When compared with previous 
figures, these show that the disease was declining. Investi- 
gations wcirc also m»de among the families and relatives of 
worm-sick miners. At Amsberg. 386 wives and 964 children 
of the miners known to be the subjects of ankylostomiasis 
were examined, but in only one case was the disease detected 
As this and another case previously reported arc the only 
cases where until that date the presence of worms has been 
established among the female relatives and the children, it is 
clear that the infection did not reside in or at tlic homes, 
but was confined to the mines. Ten to 1$ per cent, of the ' 
miners had to undergo a second course of treatment. ^U 

At five of the collieries water sprinkling was, with tll^H 
consent of the Royal Department of Mines, discontinued in 
whole or in part, so as to ascertain what would be the efTcct 
of the diminution of moisture tn the pits. No particular 
result was noticeable at the time of the publication of 
article in (7/iUiau/. 1903, vol. xxxix. p. 1138, from which 
have quoted, but it is believed chat the mines chosen were 
naturally damp, and in those that were dry sufficient time 
had not been allowed for the results of the experiment to have 
been achieved. 

At the Lothringen mine, which 1 visited with Dr, 
Tenholt, and where ankylostomiasis broke out in 1885. the 
number of infected underground workers had fallen from 7 
to $ per cent. The larva; were stilt to t>e found in the mu 







PARASITES AND MICRO-ORGANISMS 317 



water along the ^des of the roadways in the mine and in the 
wooden props which supported the roofs. How long the 
larvx are capable of living in the pit it is impossible to say, 
but in the En'n mine, a few miles away from the Lothringcn, 
I was informed by Dr. Perner, the medical officer in charge, 
that he had found in one of the disused parts of the pit the 
larva: alive and very active eight months after the gallery 
had been shut off from the other parts of the pit At the 
date of my visit experiments were being conducted at the 
Lothringcn mine by Dr. Tenholt in regard to the disinfection 
of the infected galleries by lime, but the difficulty of carrying 
this to a successful issue is apparent from the enormous 
extent of surface and the possibility of fresh infection by 
careless miners. 
I In Germany the ravages of the ankylostoma are not 
confined to the mining population : many of the brick- 
makers in the fields around Cologne arc not free from the 
parasite. Surgeon-Major Talayrach (" Annal. d'Hygifrne." 
Aoflt, 1904, p. 182), quoting from the medical statistics 
of the German Army, shows the prevalence of ankylosto- 
miasis among soldiers. This is hardly to be wondered 
at in a country where all the young men have to do com- 
pulsory military iiervlce. Talayrach is of the opinion that 
the German pits became infected by Hungarian miners 
^kvho had returned from Brazil, whither the parasite had been 
^■ntroduced by Italian mining immigrants. In Germany there 
^Pwcre in 1902 17,161 cases of ankylostomiasis out of 188,730 
' miners examined, »"*, about 9 per cent. The disease is 
not confined to Westphalia and the Khine provinces ; it is 
also met with in Luxembourg and the frontiers of Alsace- 
Lorraine. 
^ The German Goveramcrt now requires military surgeons 
^pto notify all cases of ankylostomiasis coming under their 
^cognisance. As a consequence of circularising the military 
doctors, there were reported in October, 1903, 40 cases of 
ankylostomiasis in the army, of which 33 were in the 16th 
Army Corps. Of the infected soldiers, 39 belonged to the 
mining districts of Westphalia and the Rhine provinces. A 
subsequent inquiry elicited the presence of the parasite in 




3^8 



DISEASES OF OCCUPATION 



28 men who had just finished their military service and 
bad all the appearance of gocxi health. 

An infected miner will pass in his stools myriads of on 
of the aiikylostoma, which in a few days, tf the tcmperaltue 
is favourable, will develop into living, active, and voracious 
larvK. Opinions are still divided as to whether these larvx 
can, in the sludge of a warm mine, develop Into the 
fully-developed worm. Giles affirms the fact, and bis 
observations are confirmed by Sandwith, but in none of 
the experiments I carried out with the larvae of the anky- 
lostoma of the dog was such maturity ever reachi 
While not denying the possibility^ the usual course is 
the larva: to be transferred to a host, in the upper 
reaches of whose intestinal canal transformation of the 
larvie into the sexually mature worms takes place. There 
arc several forms of ankylostoma, .r^,, that of man — in whom 
two kinds are met: (l) Ankylostoma duodenaU and (2) A 
kylosloma Amtricanwn — also the parasite whidl infects 
dog. fox, sheep, &c., but by most writers the organisms 
not considered to be interchangeable. The larva: of 
ankylostoma of the dog cannot develop into the adult worm 
in any other body than that of the dog. 

P. D.Siccardi(^//»<y.^M^ isf Vtfut<fd,Sd.VetSLc..vo\.6^, 
M, 1905-4^, in bis review of the subject of ankylostomiasis, 
maintains that the larva: of the American form of anky- 
lostoma are incapable of infecting the d<^, but that those of 
Ankyhsttftna drndtnaU can. The ova of the Antyhstoma 
Anuricanuni, or Utidnaria Amfricana, are larger than tboae 
of the Old World parasite. They resemble the ova of 
Asearis lumbricoidts that have lost their external capsule. 

At Sopron-Brennberg. Hungary, where I was the guest of 
Dr. Goldman, the medical oiHcer to the colliery, there were 
ten years ago 70 per cent of the miners infected, but at the 
d.iie of my visit 50 per cent The miners had suffered very 
severely in their general health. Several of the miners whom 
I saw at the works' hospital were ansmic and short of 
breath, their feet were swollen, and they were suffering from 
dyspeptic troubles, and yet Uie virulence of the endemic was 
on the wane. The conditions of work in the Sopron mine 



let^j 

? 

the 
ere 
lom 

I 




PARASITES AND MICRO-ORGANISMS 319 



mi 



m, 



Ik 



are peculiar. The coal is of a pitch variety. In the mine 
fires keep breaking out several times a day. The temperature 
is frequently as high as 104° F., and even higher where the 
ventilation is imperfect and water spraying not attended to. 
Owing to working in this high temperature the men arc all 

in and spare of body. Half of the time they are in the 
mine they have to leave off working and fjo into the main 
galleries to get cooled. As they perspire freely, boy.s. 

Trying water barrels on their back, keep walking up and 
down the underground roadways in order to supply pure 
drinking-water to the miners, 

\ IC is not known how ankylostomiasis reached the Hun- 
garian coal-fields. Miners from the St. Gothard tunnel are 
blamed, but the manager of the Sopron-Brennberg Colliery, 
Mr. Rudolf, informed rac that as far back as 1864 he knew 
of the existence of the miners' worm disease in Hungary. 
Evidently what takes place in the infection of coal-mines is 
something like this. Probably one diseased and thoughtless 
miner is capable of infecting a mine owing to the myriads of 
ova passed in his stools. Grassi and Parona state that one 

ntigramme of fxccs from a miner harbouring 1,000 worms 
in his intestinal canal will contain 150 to 180 ova. These, 
as we have seen, under favourable conditions develop into 
lanrx, some of which sooner or later may gain an entrance 
into the body of healthy miners. For a period everything 
goes on at the pit as previously, when all at once several of 
the miners become ill and unfit for work. When the di.>;ease 
breaks out suddenly and in many of the workmen, it is 
usually extremely virulent. This is a feature of the malady 
ivhich is lost as time goes on. 

Ankylostomiasis has shown itself in the coal-bearing 
districts of other countries. It was prevalent in the mines 
of Bohemia in 1905. Belgian miners have suffered se%'erely 
from the disease. As far back as 18S4 the malady, according 
to Firket, existed in the collieries around Lit^ge. Between 
iSS4and 1S9S there were 92 cases of ankylostomiasis treated 
in the hospital at Lii-ge, but shortly after this the number of 
cases became so large that a Commission was appointed to 
inquire into the subject Although certain sanitary recom- 




323 



DISEASES OF OCCUPATION 



India. Although the parasite in called AnJyUstama dtia- 
denait it is not confined in its habitat to the duodenal portion 
of the alimentary canal. In the dog I have found the worm 
in large numbers in the jejunum or upper portion of the »mall 
intestine. The worms, which are small threadlike bodies, 
^ary in size from S to lo mm. in length, by 04 to 0*5 in 
breadth. Tbc female is the larger of the two. By meana of 
four claw-like hooks, two on each side of the ventral line, and 
two conical teeth, one on each side of the dorsal line, the 
worm attaches itself to tbc mucous membrane of the 
intestine, and thereby secures its nutrimenL The worms 
when passed per tmum are white or grey in colour — while 
when alive, grey when dead. Others are reddish, owing to 
cont.^ining blood abstracted from their host While the tail 
end of the female parasite is pointed, that of the male is 
spread out like an umbrella and contains eleven ribs. In tbc 
female the anus is subtcrminal ; the vagina is ventral, close to 
the commencement of the lowest third of the body. In the 
male the cloaca opens into the umbrella-like bursa. 
in conjugation the worms resemble the Greek letter " 7 
The numbers of ova produced and shed by the f« 
ankylostoma are enormous. The eggs arc oval in shape, 
and have a delicate transparent membrane, through which tiie 
yolk can be seen in the stage of segmentation. The ova vary 
in length from 0*056 to Cvo6l mm. and arc always twice 
as long as they arc broad. Within three days after being 
passed by a patient the ova, under favourable circumstances, 
develop into actively moving filiform lar^'X 02 mm. in 
length, and 0X)t4 in breadth. So voracious is their appetite 
that within a week they have grown tlirice their original 
length. They twice undergo a process of moulHng, after 
which ihcy cease to be so vigorous. One reason as.<Krted for 
the ova being unable to be transformod into larvu: in the 
intestinal canal of the host is the absence of oxygen tbcrcia 
The larvae gain admission into the human body through 
water or through food, owing to workmen eating with un- 
washed hands. Until recently this was the usually accepted 
theory as to the mode of entrance into the human body, but 
it was reserved to Looss, of Cairo, who had accidentally 



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PARASITES AND MICRO-ORGANISMS 323 

infected his skin by a living cuirure. to demonstrate that 
the larv.-c penetrate the skin, enter a small vein, arc carried 
to the right side of the heart, and thence by the |)ulmonajy 
artery into the hings; Through the walls of the pulmonary 
capillaries they escape into the alveoli of the lungs, from 
which they migrate by their own gliding and lashing move- 
ment up the bronchi to the glottis, and then pass down 
the oesophagus and stomach into the duodenum and jejunum. 
Having reached this portion of the intestinal canal, the 
larva:, having in their course become more and more matured, 
attach themselves to the lining membrane of the bowel. 
It takes at least three days for the larva: to pass through 
the sUin and by the blood stream, respiratory passages 
and ccsophagus to reach the intestine. In passing through 
the skin they set up considerable irritation both in man 
and in the dog. It is thus that arc to be explained the 
peculiar eruption of small boils on the arms of the Cornwall 
tin>miners known as " bunches," and the sores and boils on the 
feet and legs of coolies working with their bare feet in the tea 
plantations in India and Ceylon, and in the fields in tropical 
countries. It is difficult to say why the \zrvx of the ankj'lo- 
stoma pass so frequently by the skin. They may passibly 
find in the intercellular fluids and in the liquor sanguinis 
something that aids their transformation into the mature 
worm, but, so far as wc know, there is no difTcrencc between 
the fully developed worms whatever their mode of entrance. 

Symptomatology. — Men who are the subjects of ankylosto- 
miasis usually complain of extreme weakness, difficulty of 
breathing on slight exertion, fluttering of the heart, rincasy 
sensations at the stomach, and swelling of the feet which pre- 
vents them walking. They are worse in the summer than in 
the winter. This periodic character of the complaint is ex- 
tremely interesting. On the approach of winter I noticed in 
my experiments upon canine ankylostomiasis that not only did 
the number of ova in the stools become diminished, but the 
ova themselves were if anything smaller and did not so readily 
develop into larvie. The larvar, too, were feebler. The dog 
which passed the ova improved in condition on the advent 
of the colder weather. On the approach of summer the ova 




yn 



DISEASES OF OCCUPATION 



became more nuaieiYMis and the larvx more active. This 
cyclical condition of things is not peculiar to ankylostocna. 
I have observed the same in an infant who was passing live 
maggots by the bowel. When the iarvar of ankylostoma, 
having penetrated the skin through a hair follicle, have 
reached the upper part of the small intestine, it ts not until 
the ninth day that their hooks are developed, and not until 
four to six weeks (Stiles), 71 days (Loo^s), after their entrance 
into the body tttat they become fully matured worms capable 
of throwing off ova in the faces. Although immature, they 
arc yet capable of inflicting great damage. The administra- 
tion to a dog of milk containing ankylostoma larvae caused 
the animal to retch and to vomit, followed in a day or two 
afterwards by signs of gastro-intestinal irritation, diarrhoea, 
and a disinclination for food. In man the early symptoms 
are also gastro-intestinal, but owing to the mode of infection 
being in all probability more through the skin, or if by the 
mouth, then owing to the fact that very few lan'£ have been 
swallowed, it is seldom that the symptoms arc those of an 
acute gastro-enteritis. The intestinal symptoms largely 
depend upon the number of larvae entering the alimentary 
canal, the idiosyncrasy and the health of the patient at the 
time. As repeated infections probably occur, the symptoms 
arc slowly developed. Gradually digestion becomes impaired 
and there is induced anivmia. The [>allor, which is at first 
slight, slowly increases, the pulse becomes feebler, the dys- 
pnoea greater, and the feet more swollen. If in this condition 
the patient continues to remain in the infected area and 
incurs the risk of fresh invasiun of his alimentary canal by 
larvx, the symptoms will become progressively worse and 
death may take place. Where the possibility of re-infectton 
is excluded and the malady is slight, the illness tends to wear 
itself out, for the individual cannot re-infect himself by the 
parasites in his intestine, except by ova passed in his stoob 
developing externally into Iar\-a; and some of these embryos 
accidentnlly gaining admission into his alimentary canal 
through food or drink. While anxmia and pallor of the body 
arc the physical signs of the disease in miners, the cooties who 
work in the fields in the tropics suffer from an eruptioo 



i 




PARASITES AND MICRO-ORGANISMS 3*5 



their skin called "ground itch" or "water itch," a similar 
eruption to that on the arms of the Cornwall miners known 
as " bunches." In persons thus afflicted it is observed that 
when the skin becomes broken or is ulcerated it does not 
heal rapidly. Stiles found "pot belly" a frequent physical 
sign of the malady in young persons. The peculiar shape of 
the abdomen is due to an extremely distended state of the 
bowel from gas and the presence of free fluid in the peritoneal 
cavity. The feet swell and in advanced cases the urine may 
contain albumen. According to Zimm and Jacoby (" Report 
on Prevalence and Geographic Distribution of Hook-worm 
Disease," Washington, U.S.A., 1903, p. 68} the urine contains 
a poison or ptomaine, so that when the urine is injected into 
the vein of a healthy animal it causes destruction of the red 
blood corpuscles. The farces may be neutral, alkaline, or 
acid. I have found that the transformation of ova into larva: 
takes place quite irrespective of the chemical reaction of the 
stooLs. This transformation may occur in 34 to 36 hours. 
Fully developed larv£ of the Ankyhstoma dvodtnaU are not 
found in the recently passed stools of patients. When larva: 
arc thus found they are the immature form.* of another para- 
site, usually the Strongyleidfs stenoralis, which is the cause 
of Cochin-China diarrhcea, and the fully matured worms of 
which often co-exist in the human intestine along with ihc 
ankylostoma. In fact, there are frequently present in infected 
miners more than one form of parasite in the alimentary 
canal, the differentiation of which rests upon microscopical 
examination of tlie various kinds of ova present in the farces. 
In some patients the bloodlessness or ansmia is very 
pronounced. The degree of ana;mia is generally, but not 
always, proportional to the number of worms in the intestine. 
The red blood corpuscles are reduced in number, and there is 
a marked fall in the amount of haemoglobin or red colouring 
matter. The eosinophilc corpuscles, a variety of the white, 
are usually increased in number. Instead of there bcinf; 
5^000,000 red blood corpuscles in i cmm. of blood, there may 
be only 3,000,000 to 1,500,000; and thccosinophilc corpuscles, 
which are normally present to the extent of 2 to 4 per ccnL 
of the white corpuscles, may rise to i3 per cent. Any difR- 




328 



DISEASES OF OCCUPATION 



into the patient's body through the punctured wounds in the 
mucous membrane caused by the houklcts of the parasite. 
The presence of ankylostomcs in the intestine, thcref3re, 
opens the door to secondary infection by micro-oi^anisms 
from the alimentary canai, which induces such a serious state 
of body as to cause death. 

The extension of the disease from an infected miner to his 
children is in Europe, as ah'eady stated, an uncommon occur- 
rence. Cases, however, have been reported, M, O. Cozzolino 
{Pediatric, Fdvricr, 1907) found the diseaie in two twin sisters 
two and a half years of age, the children of an Italian miner in 
Genoa, who had recently arrived from Brazil, both of whom 
died. In the upper partofthcamall intestine in one there were 
found, at the autopsy, upwards of two hundred ankylostomes, 
and numerous small hemorrhages in the mucous membrane. 
These children had all the appearance of pernicious anaemia: 
the red blood corpuscles numbered 2,6oo/x)0 per c-mm. of 
blood without any notable eosinof^lia. During life the ova 
of the parasite had been found in the stools. As the parents 
with their family had only recently returned from South 
America, it is hardly right to regard the presence of the disease 
in the children as having been necessarily associated with the 
work of the father. It is more than tikcly that tlie ankylo- 
stomiasis was endemic in the place where they had lived. 

Treatment of A nkyhstomtasis. — The treatment of this 
disease is preventive and curative. As the presence of 
one infected careless workman in a mine may be foU 
lowed by infection of that mine, experience has shown 
the desirability of mine-owners getting made for them a 
microscopical examination of the fa:ces of suspected miners 
and of men who have come from an infected district, since 
in our own country, apart from Cornwall, three or four cases 
of ankylostomiasis have been found among miners who have 
returned from India and elsewhere. The necessity of watch- 
fulness is at once apparent The ova of Ankyhstoma 
duodtnale do not hatch readily at low temperatures, but 
because the temperature of British coal-mincs is usually 
lower than that of many of the pits on the Continent, and 
the ventilation of our collieries is considered to be better, 



PARASITES AND MICRO-ORGANISMS 329 



there is an idea that our coal-pits do not offer the con- 
ditions favourable to the development of the parasite. As a 
mining country wc have no right to hug this belief, and 
close our eyes to the necessity of instituting watchful and 
preventive measures. 

Dr. Lambinct, who is in charge of the Miners' Dispensary 
at Li^e, fouiul that the ova of ankylostoma could be 
hatched at temperatures lower than 60^ F., and Haldane 
even as low as 4$° F. I have kept ova in a cold cellar at 
a temperature of 50° F. for six weeks to two months, and 
yet at the end of that time found that the larv.-E which 
developed were extremely strong and vigorous — in fact, it 
Oecmcd as if the exposure to a low temperature had rather 
improved than diminished their vitality. This was not 
always the case, however, for after exposures to low tem- 
peratures the ova required fifteen days to change into larva;. 
I have placed ova in freezing mixtures of ice, and kept them 
at 1° C for more than an hour, and yet forty>cight hours 
afterwards the ova became transformed into \a.rvx. There 
is, therefore, no real security from ankylostomiasis because 
of the lower temperatures in British coal-mines compared 
with those of the Continent The ova require a certain 
amount of water and oxygen. U is partly owing to the 
absence of oxygen and to the rather high temperature of 
the human body that the ova do not become transformed 
into larvx in the alimentary canal, and yet on one occasion 
I exposed larva: to a temperature of 99P F. — practically 
speaking, the temperature of the human body — for twenty- 
four hours, and on the following day they were still alive. 
In addition larv£ which I had put into an artificial gastric 
juice were, at the end of live days, still living and 
mobile. 

Water-closets should be provided for the men at the pit 
mouth, and their use encouraged. In infected mines portable 
dry closets or covered iron pails should be provided for the use 
of the men working underground. The deposition of faeces by 
the men elsewhere than in the receptacles provided for this pur- 
pose should be made penal. The pails or receptacles should 
be taken out of the mine daily, rinsed with boiling water 



330 



DISEASES OK OCCUPATION 



and thoroughly disinfected. The miners should wash their 
hands well before calinf;. Instruction should be given to 
the workmen upon the lifc-history of the parasite, so as to 
secure their intelligent co-operation. Fresh miners, who have 
worked in tropical or mid-European countries, on applying 
for employment in British mines should have their (secea 
raicroscopically examined before being accepted- Free 
ventilation of the pits and a coo) temperature therein arc 
aids to prevention. At my visit to the Westphalian coal- 
mines 1 found Dr. Tenholt carrying out a scries of experi- 
ments with antiseptics as to the possible destniction of ova 
and larva: in one of the galleries of the Lothringen mine. 
The temperature was rather high. The sides of the gallery 
to the extent of 3 feet upwards, and the wooden props in 
a similar way, were being .sprinkled with a strong solution of 
lime, but the results were not so satisfactory as had been 
anticipated. The resistance of the ankylostoma larvx to dis- 
infectants of all kinds is remarkable, unless the solutions used 
arc of such strength as to become dangerous in their general 
application. It has been known for some time that mines 
into which salt or sea water has trickled exhibit a remarkable 
freedom from ankylostomiasis, while contiguous mines not so 
circumstanced are infected. Manouvricz, of Valenciennes, 
was one of the first to demonstrate this fact, which 6nds 
corroboration in the tin-mines of Cornwall. The Lc\'3nt 
tninc contains water in which sea salt to the extent of 
373 per cent, has been found. This mine is free from the 
ankylaitoma. I^ambinet, of Liege, has carried out a series 
of experiments with salt water. If the Iar\-a: are simply 
deprived of water alone — that is to say, undergo gradual 
desiccation — they shrink inside their capsule ; and if the 
process of drying has been carried too far, it is impossible 
to reanimate the shrivcllcd-up )arv%. If, under the influence 
of exposure to a ij per cent solution of sodium chloride, the 
abstraction of water from the larva: has not been carried too 
far, there is simply arrest of movement after tweitty-four 
hours' exposure ; but if the salt water is replaced by pure 
water, the movements gradually return and the larva: arc 
soon brisk again. A 30 per cent, solution of common salt 



PARASITES AND MICRO-ORGANISMS 33» 



or strong glycerine caus*:s such a retraction and withering 
of ihe larv.i; that even when re-hytlrated it is impossible 
to restore movement, for the larvae have been killed owing 
to brealcing up of their substance by plasmolysis. Lambinet 
submitted larva: for twenty-four hours to solutions of chloride 
of sodium varying from 2 to 15 per cent It was only at the 
higjher perccnt^c that the movements of the larva: became 
impaired or ceased, and not until a 30 per cent, solution was 
employed that death of the lar\'s was fully assured. The ova 
of Ihe ahkylostoma were destroyed by a feebler saline solution 
than the larva:. A 4 per cent, solution of salt absolutely 
prevented the oxra becoming transformed into larva; ; smaller 
percent^es only retarded the transformation. In an infected 
mine the repeated spraying of the walls with concentrate*! 
solution!) of common salt would be worth tryinp. This 
would be in pits an inexpensive mctliod of getting rid of 
the pest, but to be successful strong solutions would have to 
be used. 

Since the publication of Lambinct's experiments fresh 
support to the theory of the protective influence of sea sail 
solution in mines has been announced by M. L. Tirclli,' 
who is officially attached to the sulphur mines of Trez^a 
Albini, Komagna. Tirclli noticed that some mines were free 
ffom the ankylosloma, while others, despite all precautions, 
regularly furnished a large number of cases. The geological 
structure of all the mines is the same. The mines that are 
free are the driest, but immunity from the para.site does not 
dejicnd upon this circumstance, for there is plenty of mois> 
ture for the larvn; to live and thrive in. On examining the 
water Tirclli found that it contained difTcrcnt quantities of 
sodium chloride, varying in some mines from 0*009 P*^^ cent, 
to 19 per cent, in others, ako tliat the mine^ in which the 
water contained i per cent, were infected, while those in 
which the water contained 2 per cent, and upwards were 
free. The fact that the ova of the ankylostoma cannot live 
in water containing 2 per cent, and upwards of common salt 
points the way along which infected mines may be cleared 
of the larvae. The galleries must be sprayed with strong 
" Riv, d'Igiene e Suiita," publiiliod 19 Mars, it/yj. 



332 



DISEASES OF OCCUPATION 



solutions of chloride of sodium, as recommended in the 
preceding paragraph. 

In the treatment of patients by medicine reliance must 
be placed upon the internal administration of aperients and 
vermifuges. Of purgatives allusion need only be made to 
a few, such as castor oil, jaiap, and calomel. Before giving 
intestinal antiseptics it is always well to clear out the bovrels 
first and to put the patient on liquid diet for at least one 
day. In Westphalia I found extract of male fern was given 
by Tcnhoit ; but in large doses, frequently re]>eated, he bad 
noticed that it caused ncuro- retinitis, and that in at least 
one case its administration had been followed by permanent 
blindness. The introduction of thymol by Bozzolo, in iSSo, 
has placed in the hands of the medical profession a more 
reliable drug than male fern, and one, on the whole, safer if 
certain precautions arc attended to. The efficacy of the drug 
depends largely u|>on the fact that it is insoluble in tbe 
alimentary canal, and is, therefore, capable of acting upon 
a considerable length of the intestine. Collapse and alarm- 
ing symptoms have occasionally shown thein.iclve& after Its 
use. Thymol, to be of any good, must be given in doses from 
I S to 30 grains every two hours until four or six doses of the 
drug have been taken, when the bowels should be relie%-ed 
by means of a purgative, unless previously opened sponta- 
neously. The dru}:; is best given in cachets, or in tablet 
form. It is extremely soluble in alcohol, ether, turpentine, 
chloroform, oil, glycerine, and some alkaline solutions, so 
that durin}{ a course of thymol treatment these agents should 
be avoided. When, in a patient who is taking thymol, the 
urine becomes dark brown in colour, and there develop such 
symptoms as delirium and vertigo, it is time to discontinue 
the drug. 

Goldman, of Sopron>Brcnnberg, uses a compound which is 
efficacious, and which he calls ankyl.' In one of his patients, 
whom 1 saw with him, there were, as the result of a single 



■ Goldman alMi named the prcpuralion taniioi. II is oMaincd from 
tlifi rind oi Mu&sciina Ahy^imca, a MyrHiDai;«a found in PvrsuL. The 
Mtiv« principle of the drug is not well known chemically ; it U b«9| 
given with thymol. 




PARASITES AN'D MICRO-ORGANISMS 333 



Jministration or the medicine given four hours prtt'ious to 
my visit, fully one hundred mature wunns passed in the 
dejection. Beta-naphthol, eucalyptus oil, and areca nut, with 
a host of other drugs, have been tried. The proof that the 
treatment is doing good is the presence of the worms, dead 
' or alive, in the stools. After discontinuing the antiseptic 
treatment for a week, the fieces shoold be again micro- 
scopically examined for ova, and, if present, the treatment 
must be renewed. 

Since the presence of salt in the water trickling down the 
galleries of a mine is a preventive of ankylostomiasis, it has 
been recommended to replace the antiseptic treatment in the 
case of infected miners by common salt in large doses. 
Chloride of sodium in days gone by was regarded as a 
safe and reliable anthelmintic. It has to be given in large 
doses, say, half an ounce to three-quarters. Administered in 
the form of a concentrated solution, it loses to a great extent 
its power of being absorbed ; it passes on into the intestine, 
where it acts as an aperient, causes detachment of the worm 
from the mucous membrane, and aids in its expulsion from 
the body. To prevent the absorption of the sodium chloride 
it is well to saturate the solution of common salt with bicar- 
bonate of soda, i£,,6 drama of chloride of sodium, 2 drams of 
bicarbonate of soda in 5 to 6 ounces of water. Experi- 
ments upon animals that harboured intestinal worms gave 
good results with sodium chloride. 

Notwithstanding all that is done in the way of medicinal 
treatment, a few ankylostomata often remain adherent to the 
intestinal mucous membrane and seem to be uninfluenced 
by drugs. It is thus that we seek to explain the fact that 
in a mine that has been infected, despite all the prophylactic 
and curative measures tliat have been taken, there still remain 
5 to 9 per cent of the men in whose fxccs the ova can be 
The points that have struck me in regard to ankylo- 
is arc the silent march of the disease from mine to 
mine and from one mining centre to another, the long latent 
period of its incubation, the suddenness of its outbursts, and 
the extreme virulence of the endemic when it first appears 
compared with what it is later on. 



PARASITES AND MICRO-ORGANISMS 335 



For several years past anthrax has been at times a 
. \*cntablc scoui^c in Bradford and in the woollen districts 
of the West Riding of Yorkshire, where about three-fouiths 
of all the foreiRn wool imported into this country is manipu- 
lated. The disease is met with, too, in Worcestershire 
In the woollen districts of the South of England and of 
Scotland anthrax has been conspicuously absent, owing 
to the fact that only colonial and homc«grown wool is 
manipulated in the»e places. In London and Liverpool 
anthrax is well known. Dr. T. M. Legg* '" his Milroy 
Lectures {Lancet, March iS, 1905) has gathered together 
nearly all that is known of woolsorters' disease. He states 
that during the six years 1899 *^ '904. there were reported 
to the Home Office 261 cases of anthrax contracted in 
factories and wor k&hops. Of these S8 occurred in worsted and 
wool factories, 70 in horsehair and bristle works, 86 in hides 
and skins, and 17 in other industries; 224 of the sufferers 
were males and 37 were females ; 67 of the cases proved 
fatal. The disease has appeared mostly in the wool-sorting, 
wool-combing and spinning industries, in the manipulation 
of horsehair for stuffing chairs and mattresses, and in the 
preparation of bristles for brush-making. Anthrax has 
also been met with in persons employed in tanyards and 
in warehouses connected with docks. An idea may 
be formed of the importance of these trades by a reference 
to the number of persons employed in them. The wool, 
worsted, and shoddy industries of the United Kingdom 
gave employment in 1901 to 259,909 persons (lo6,S98 males 
and 153,311 females), but of this number only 1,171 (1,164 
males and 7 females) were engaged in sorting, and iflg% 
(1,882 males and 1,211 females) in combing the dangerous 
wools. In horsehair factories according to a recent Home 
Office RejKirt the total number of persons employed is 
2,535 and in brush>making factories and workshops 6] I 
and 11.753 respectively. Of the two industries wool and 
horsehair it is found that persons employed in horsehair 
are the more liable to the disease. The percentage of 
cases of anthrax m bristle works is »mall. The danger 
resides in the handling of the hides and fleeces of infected 




DISEASES OF OCCUPATION 

animals ; hence the occurrence of the disease in ranncfs aad 
farm labourera, butchers, and meat iospectors. Dusty wwb 
and "fallen fleeces "— i;*.. fieect^s of animals that have (Bed 
from anthrax— are the most dangerous. According tD the 
method of infection in man, so a the t> pe of the disease 
The mode of infection is largely determined bj- the oatun ot 
the employment. Anthrax is a general disease when the 
bactllus or its spores have gained access to the Uood-stnam, 
or it may givx rise to a local red and painfbl swctlbe 
called " malignant pustule." Of these the fanner is the man 
dai^erotis since it implies a widespread tnlcctian of the 
system. In Ncwcastle-upon-T>Tie anthrax in any other torn 
than malignant pustule is hardly krtown. My own experi- 
ence of the disease is drawn from its Umited inantfcsQUiocK 
in tfaefcwin <rf pustule oa the cheek and neck of butcfaen 
and cattle saksaco. These are the parts of the body mast 
Itafaie to be aftcted, bot the anns and fingen aie by no 
means exempted. In additioo to the f»«*»4 ar Sotm eboe 
occurs an aysipdatoos type viiidh is known as mal^snt 
cedctoa. 

It is estimated that there are about l,oaa cass o^ aathiax 
m a n i— h aano^ly in Grtat Bcitaia ; bat tlm b only coe- 
faavtb cl wtet oecan ta Gaamnjr aad Italy, wlule in 
Eirapeaa Rassii and tke raarat Ae ■amber U cases 'a 
ftabatty 40fioo a yeas; 

la t^B <o a nt iy aaasaa b moA fteq^Bad|y doe to the 
otnnoe fan ibe bodbr of Ihe spans of tte J^Obr «i«AKu 

aokair from Aaanc Taik^, ^ib han^av from rytf in^ 
botfks from SAcna. aad ^T^i^fc ^ l a^a apd Cbtna. 

Ufe. 

as 



• wfaea 



PARASITES AND MICRO-ORGANISMS 339 



Tectiiig stations been erected, where wool and hair can thus 
be dealt with, but theru is ;i Go%-ernment regulation to the 
effect that "aJl foreign horsehair, cowhair, or goathair. pigs' 
bristles, and wool, before they are manipulated in the factory 
shall be disinfected at the choice of the occupier in one of the 
following prescribed ways : — 

" I. By the action, for at least half an hour, of current steam 
at 0*15 atmosphere above atmospheric pressure (about 17 lbs., 
and equivalent to a temperature of 220* F.)i 

"2. By boiling for at least a quarter of an hour in a 3 per 
cent, solution of potassium permanganate, and subsequent 
bleaching in a 3 to 4 per cent solution of sulphurous add. 
"3. By boiling in water for at least two hours." 
In his Report on Anthrax (1906) Dr. T. M. LcRge states 
that experiments carried out at the Imperial Oflicc, Berlin, 
have shown that so long as the pressure does not exceed 
2j lbs. above atmospheric pressure, equivalent to a tempera- 
ture of 320° F., long hair will sufTcr no damage Curled hair 
can be submitted to higher temperatures. The adoption of 
these and other means of disinfection would materially reduce 
the risk from anthrax, if it did not abolish the risk entirely. 

Symptomatology. — The eflects of the entrance of anthrax 
bacilli or spores into the human body may be local or 
general. When local the disease causes a hard, red swelling, 
known as " malignant pustule," usually situated on the face or 
reck, and which, if seen early by the sui^con, can be excised 
with success, for at this stage of the malady the bacilli 
multiply slowly at the point of Inoculation, and the organisms 

rare not found in the blood. Around the margin of the 
pustule there are signs of inAammatory cedema, of a reac- 
tionary nature, which is a protective barrier to the system. 
If the organism effects an entrance it can only be by ratlicr a 
roundabout path, for the lymphatic glands are likely to offer 
obstruction. General infection of the system can only occur 
after the cells of the tissues at the local point of infection 
^Kbavc become weakened in their struggle with the bacilli or 
when their protoplasm has become poisoned by the toxins 
iormcd by the micro-organism. The patients with malignant 
ustulc operated upon in the Newcastle Infirmary made, with 




MO 



DISEASES OF OCCUPATION 



one or two exceptions, a satisfactory recovery, sliowing that 

up to a certain point the discfise is local. Excision of the 
pustule is almost sure to be followed by disfigitreroent, but 
this possible result must not be allottxd to weigh a^inst the 
tisii to life by leaving the pustule alone. In the erysipelatous 
Torm or anthrax, or malignant oedema, as it is sometimes 
called, the appearance presented by the i>atient so closely 
resembles that observed in ordinary erysipelas with tcdema 
that the one disease might be readily mistaken for the other, 
were it not for the fact that there is less constitutional dis- 
turbance In malignant oedema. The detectionof the BaciUus 
attthrach in the culture made from serum withdrawn from 
the afTected part would settle the diagnosis. The erysipela- 
tous form of the malady is more fatal than malignant pustule- 
When the tissues over a considerable area around an 
anthrax pustule on the face or neck become inflamed and 
tcdcmatous. the half of the face or neck affected assumes 
enormous proportions, and the patients complain when the 
neck IS swollen, as if they were being choked. One patient 
whom I saw in this condition, and who was perfectly rational 
at the time of my visit, whose pulsc-ratc was 132 per minute, 
temperature 103° and whose lungs and heart were healthy, 
suddenly became delirious a few hours afterwards, ran up 
and down the Infirmary ward, and ultimately shut himself 
up in a room in a state of frenzy. This outburst of acute 
toxic delirium was followed by extreme exhaustion, and 
shortly afterwards l^ death. This patient had received 
serum treatment, but it was of no benefit to him. 

Woolsorters' disease is the pulmonary form of anthrax. 
It was observed in sorters of alpaca and mohair in Bradford 
as far back as 1S46. Since then it has been met with in pcr>^ 
sons who manipulate camcls'-hair, Persian hair, and dustj^^ 
foreign W00I.S owing to inhalation of the anthrax spores in 1 
llic dust given off by these animal products. Although 
finthrax is extremely fatal when the micro-organism hai 
invaded the system through the lungs, ttie absence of acute, 
sc\'crc. and painful symptoms from the commencement of the 
illness until death is noteworthy. There is noneof the severe 1 
rigor nor of the shivering which so frequently tisbcrs to 



PARASITES AND MICRO-ORGANISMS 341 

acute infectiuus diseases. If there is shivering, it is slight ; 
it is more a sensation or chilliness that is complained of than 
anything else. Fain, cough, vomiting, and diarrhtca arc not 
prominent features. An uncomfortable sensation at the pit 
of the stomach is often complained of. Although there may 
be little cough, the breathing is embarrassed, and there is 
a sense of tightness and oppression about the chest. Expec- 
toration is not abundant, and only occasionally is it rusty- 
coloured, as in pneumonia. On percussing the chest-wall 
slight dulness may be detected over the base of one lung, 
usually the right, and on auscultation the respiratory murmur 
is feet^e, or it is attended by moist bronchial rftles and crepi- 
tations. Subsequently the physical signs suggest the presence 
of fluid in the chest. The pulse is feeble and the heart's 
sounds are weak. The skin presents a dusky appearance, and 
is cold to the touch ; the patient exhibits signs of collapse. 
With all this the mind remains clear to the last, or the patient 
dies in a state of coma, with or without convulsions. The 
urine is scanty, and often contains albumen. Pyrexia is not 
a prominent feature. Should a rise of tcmpcratun: to io3<> F. 
occur, it generally betokens widespread infection or a septic 
pneumonia. In the pulmonary form of anthrax death gene- 
rally comes any time from the second to the fourth day. 
The characteristic feature of this form of the malady is the 
rapidity with which collapse sets in. After death the body 
decomposes very rapidly. There is extensive livid di.s- 
colouration of the skin of the face and neck, of the skin 
of the trunk and posterior parts of the body, and on incising 
the skin of the chest-wall bubbles of air escape, owing to the 
existence of subcutaneous emphysema and commencing 
gangrene. In the pleural cavity there is usually some straw- 
coloured fluid. A thick layer of gelatinous material covers the 
lungs, which on section arc found to be gorged with black fluid 
blood, with here and there small patches of red consolidation 
or hxmorrhages. The bronchial glands are enlarged. Co 
the surface of the heart and in its substance are numerous 
petechial hemorrhages. In the abdominal cavity there is 
gelatinous-looking fluid. The spleen may or may not be 
enlarged. On examining the brain hxmorrhages may be 




PARASITES AND MICRO-ORGANISMS 343 



P 



1904, the serum treatment ha-s been tried in England 
either alone or in connection wiUi excision, in 12 cases of 
external anthrax. In 4 of these 12 cases serum alone was 
used — one of these, which was far advanced before the scrum 
was adopted, died. Strong testimony to the efficacy of the 
scrum treatment comes from Santa Croce, a small town on 
the Ama Here 36 tanneries give employment to 550 
persons. Among the workers who manipulate China hides 
anthrax has been frequent and fatal. So convinced are die 
workmen of the beneficial cflccts of the scrum treatment that 
they insist on having it to the e>rclusion of all other means. 
The peasantry of the district around Siena when ill often 
make their way into that town voluntarily to receive treat- 
ment The immunity conferred upon sheep and cattle by 
injecting into tliem anti*anthrax scrum is now a recognised 
fact. The result of a series of experiments carried out by 
isobcrnheim confirms the opinion cxpicsscd by Sclavo that 
the use of anti-anthrax serum Is free from danger and is very 
effective, that it protects the animal from all forms of anthrax, 
inctudii^ the intestinal, and that it can be used for curative 
purposes in man with safety. The inoculation treatment of 
infected persons by serum, specially prepared on the lines 
recommended by Sclavo, gives promise of great success, and 
ought to be tried early in every case of the pulmonary form 
of anthrax — which has hitherto been defiant of all mcxiicinal 
treatment. 

While the disease is to some extent prevented by the bales 
of wool and hair being opened in wool and hair sorting 
factories in closed spaces with stron)^ draught removing the 
dust away from the workers, not less than ^5 cubic feet 
of air per minute being thus drawn away by the fan, it is 
advisable todisinfcct the material first Dusty and dangerous 
wools, such as van mohair and Persian, require to be 
thoroughly steeped in water in the bale before being opened, 
and the bales are only allowed to be opened by experienced 
workmen who have some skill in discerning flaws in the 
material. In steam we have a means of disinfecting hair 
,yj,ich deserves to be given a trial. To be effective, as Dr. 
jLcgge, in his *' Report on the Incidence of Anthrax," 190&, 




344 



DtSEASES'OF OCCUPATION 



says, " The steam must be in contact with the material in a 
loo-scncd condition for a sufficiently long time and at a suffi- 
ctently high tempeniture, but In order that the nratcrial may 
not be injured this temperature must not exceed certain 
limitH." Further, the conditions in which the steam is used, 
whether saturated or superheated, as current or confined 
steam, largely determine its efficiency, "To obtain the best 
results formation of moisture in the steam in contact with 
the material to be disinfected is necessary, the steam should 
be subjected to a slight degree of pressure, and the steam be 
allowed to stream through the apparatus until the air has been 
wholly expelled from the chamber. . . . Disinfection is 
brought about by the steam coming into contact with a 
colder surface, on which it condenses, and in so doing it^J 
gives up its latent heat (sufficient to raise from fifteen ta^| 
sixteen limes it* own weight of wool from c F. to 212** F.)." 
Anthrax spores are not so readily destroyed by heat at aie 
the fully developed bacilli. In the experiments carried out 
in Berlin it was found that even long hair exposed to steam 
under a pressure of 28 lbs, above atmospheric pressure, 
equivalent to a temperature of 23(7> F., suffered no damage 
for manufacturing purposes and sale. Since the enforcement 
In Germany of the regulation introduced in 1S99 requiring 
that hair shall be boiled for at least two hours in water 
or for a quarter of an hour in a 2 per cent, solution of 
potassium permanganate, with subsequent bleaching in a 3 to 
4 per cent, of sulphurous acid, the number of cases of anthrax 
in that country has markedly diminished. In England 
higher steam pressures have been used than in Germany, 
and with success. Boiling or disinfecting by steam the 
suspected material can, on the whole, be relied upon as likely 
to confer security upon the workmen, but for success to 
attained attention to minute details is necessary. 

In the Draft Regulations recently issued by the Home 
Secretary (May. 1907) re anthrax in the use of horsehair, it 
b stated that arrangements will be made whereby a large 
proportion of the horsehair can be disinfected by or for the 
importers before distribution to the manufacturers. This 
disinfection of the material on its entrance into the country 



.":■ 



PARASITES AND MICRO-ORGANISMS 345 

ought to be followed by good results. All horsehair should 
be disinfected except the white and Upht grey hair, which 
might suffer damage in the process. The Home Secretary 
has excluded bristles from the order, but although excluded 
from the Regulations the hope is expressed that when the 
disinfecting apparatus is installed manufacturers will adopt 
the practice of having undressed bristles also disinfected. 
Between January I, 1906, and March 31, 1907, there were 
seventeen cases of anthrax, including six deaths, tn con* 
ncction with horsehair and bristles. 



Hospiial Nursing 

The hospital, private, and district nurse has come to stay. 
As to the utility and helpfulness of the trained nurse there 
can be no question. But for her assistance medical and 
surgical skill would be robbed of much of its power for good. 
Attractive to women as hospital and private nursing is, the 
work is at times anxious and trequcntly fatiguing. The 
hours arc often long. Many nurses after being on duty in 
the wards of a hospital all day are thoroughly tired at night, 
and their feet are tender and swollen. If the hospital is so 
placed that the nurses can steep in good air a short distance 
from the hospital and in quiet surroundings, the gain to health 
and fitness for work are noticeable. Only strong, healthy, 
and well-developcd women, with a distinct love for the work 
and sympathy with suffering, should undertake the duties of 
a hospital nurse, for there is much to try their patience and 
temper. Their feet should be good. As a consequence of 
spending the greater part of each day in iniinnary wards which 
arc not alwa>'s too well ventilated, many nurses suffer from 
what is known as " hospital throat." Occasionally the sore 
throat becomes septic. Nurses who arc in attendance upon 
patients with infectious diseases, such as scarlet fever, may 
become the victims of infection ; others who are looking after 
septic ca.'fcs may through a small wound on their finger 
become infected and suffer from blood-poisoning. There is 
the risk, too, of tuberculosis. The records of hospitals for 
the treatment of consumption, abo of sanatoria, do not show 




348 



DISEASES OF OCCUPATION 



of criminals, but even with this voltage it has occasionally 
bappenetl that the heart uf the electrocuted criminal began 
to beat again and respiration to be restarted, so thit a 
fresh electrical contact had to be made. The result tn cvety 
instance depends upon the manner in which contact with 
the livx metal is made. If the skin is moist and unprotected, 
if the person is wearing damp boots and standing upon an 
earthed metal plate, these conditions tend to magnify the 
effects produced by contact, so that a direct current of 250 
volts, and even less, may prove fatal. In Great Britain 
there have been several deaths from electric shoclt, but 
considering the extent to which electricity is used, and its 
increasing employment, it is astonishing that there have not 
been more fatalities. At the electrical stations ofclectncily 
supply companies throughout the country there were in 
19'^ 39 accidents, z of which were fatal: in private 
electrical generating stations, 14 accidents, none of which 
proved fatal. In factories and engineering works, &c, there 
were in 1906 199 accidents, 8 of which were fataL This 
is a considerable increase in the number of accidenu in 
factories and engineering works over those of the previous 
year, viz.. 199 as against 122, or an increase of 60 per cent, 
with 8 fatalities as against 4 in 1905. It is not always 
easy to get woritmcn to appreciate the dangers incidental to 
their calling. Since, for example, the cleaning or repairing 
of "live" switchboards is a cause of fatal accidents, this 
ought to be done when the pressure is off. There is no occu- 
pation, unless it be that of the manufacture of explosives, in 
which it is more desirable to employ healthy, well educated, 
careful and capable men, to whom the dangers of the 
occupation should be pointed out, than in the generation and 
distribution of electricity. There is no proof that one person 
is more susceptible to electricity than another. It b 
entirety a question of mode of contact and how the current 
enters the body. Accidental contact may occur with any 
person, but even fatalities from accidental contact can be 
diminished by the exercise of care based upon knowledge of 
the danger. Faulty construction of switches and installation 
of cheap machinery are often causes of bums. Opinioits arc_ 



ELECTRICITY AND ELECTRIC WELDING 349 



I 



divided as to whether high-pressure alternating currents are 
more deadly Chan direct or continuous. It has been stated 
;hat alternating currents are twice as dangerous as the 
continuous, but this requires conBrmation. The continuous 
current at high tension causes burns and considerable de- 
struction of the tissues, but if the shock has been severe it 
causes death. With alternating currents burns also occur, 
but they are usually less sevcre> and the destruction of the 
tissues is less. D'Arsonval maintains that the continuous 
current is only risky to life when the circuit is broken, but 
other experts state that while the shock may be greater 
when the circuit is broken, closure of the circuit is not free 
from danger. One consequence of contact with high elec- 
trical currents is burning. The wounds in6ictcd are deep, 
irregular, and are apt to slough, and while the burned part 
Is insensitive to pain, the surrounding parts, owing to their 
being in a stale of inflammation, are extremely sensitive. 

To the dangers attendant upon using electricity for 
lighting and heating purposes must be added those of the 
live rail. As a means of locomotion electricity is destined 
to play an important part in the future of railway travelling. 
It is freely used by the Nortli- Eastern Railway Company 
on some of the local lines in and around Newcastle-upon- 
Tyne, and for a considerable time after its introduction it 
a cause of death to men and children, as well as to 

linals that had strayed upon the line and had accidentally 
touched the live rail. Dogs are still slaughtered by it. and 
t.«ccasionally a fox gets killed. I saw on two or three occa- 
Bions, with Dr. Alfred WiLson, of \VaIlsend,a man who had 
accidentally touched with one foot the elevated rail, which 
was charged with electricity. He immediately fell. For- 
tunately the accident was witnessed by a signalman, who 
left his box and rendered assistance. The injured man 
was removed from the rails in a stale of coma attended 
by convulsions. For a few hours after reaching home he 
remained unconscious. When I saw him two days after the 
accident there were extensive bums on his head and a 
wound with blisters on the sole of the right foot Within 
a few days the wound on the foot had sloughed so that 



350 



DISEASES OF OCCUPATION 



the bone of the big toe was exposed. The bone ultl? 
nutcl)' became necrosed and had to be removed. What 
struck me about the wounds inflicted by the live rail were 
their severity and the red, angry look they assumed. A 
OKMith after the injury the wounds were irritable, painful, 
and not disposed to heal. An interesting point, too, in this 
case was that the man's foot had been literally split without 
the boot he was wearing showing the slightest injury.* 

Dangers to life incidental to the use of electricity wis 
one of the subjects referred to the Dangerous Trades Cora* 
mtttcc of the Home Odice. As a member of that committee 
1 felt that before expressing my personal opinion upon the 
matter it was desirable to know how death was brought 
about in electric shock. I submitted dogs to the influence 
of electric shock (^Brit. Med. Joum.^ January 15, 1898), 
and [ concluded that death was due to sudden arrest of 
the heart's action. The immediate effect of passing high 
electrical currents through an animal is to throw the whole 
body into a state of extreme muscular rigidity, as in opis- 
thotonos. On breaking the current the respiration becomes 
quicker and deeper than before the contact and the beat of 
the heart gradually returns to the normal. It occasionally 
happened that in a dog apparently killed by electricity the 
heart's action would entirely cease, no beat could be beard 
nor pulse felt, and yet, although to all appearances dead, the 
animal would bark loudly for a minute or two, the heart 
never again beaUng. Theoretically it is usually thought that 
it is the respiration that is first affected and that death in 
electric shock comes from the respiratory centre. Such was 
not my experience, and in this I am supported by Professor 
Prevost, of Geneva University, and by his assistant, Dr. Bat* 
tclli, whose experience is that no matter whether the direct or 
alternating current is used, death is the result of the heart be- 
coming paralysed. With high voltages, <r^., 550 volts, the beat 

■ In .1 " Rotuni" presented lo lti« House of Lords, August, 1907, of 
the number of persons in jurtd by" live rails" on it electrified railways, 
there occur the following fij^uret. In 1904 (htre were 8 persons kllwd 
and 10 injured; 1005,3 killed and 18 injured; 1906. 4 Killed aod ai 
injured ; And for 8 laonthi, 1907, a kilk-d luid n injurtKl. Total, 190^ 
to AuguU, iqo7 : 16 killed and 71 injured. Of Ibe 16 killed, 12 were 
trespat&ers and 4 n«re railway Movants. 



ELECTRICITY AND ELECTRIC WELDING 351 



* 



of the heart of an animal might become suddenly arrested liy 
one shock, and after suspension of the respiration for a few 
seconds the breathing might aQ;ain return for a short time, 
then gradually become feebler and feebler until life came to 
ail end. When a man receives an electric shock and is not 
rendered unconscious by it, terror may cause him to faint 

Opinions as to the cause of death in electric shock other 
than those just mentioned have been published. Grange 
{^Laatet^ August 30, 1904) attributed death to hxmorrha^ 
into the medulla oblongata, which by pTCssin{; upon the 
pncumc^astric nerve induced respiratory failure and arrest 
of the heart's action. D'Arsonval believes that in the 
strong local effects which are produced, not only are the 
physiological properties of the tissues destroyed, but the 
local conditions reflexly and indirectly cause inhibition of the 
respiratory and cardiac centres. Of the two main views as 
to the cause of death that are generally advanced, respiratory 
arrest or cardiac failure, I lean to sudden stoppage of the beat 
of the heart. From what has just been said it is clear that 
the mechanism of death in electrocution is still a matter 
of dispute. It is possible that electrocution only causes 
apparent death, and that the real cessation of life is brought 
about by want of proper care and effort to set going again 
the beat of the heart and the play of the lungs. In death 
after electric shock Jcllinek. of Vienna, found on lumbar 
puncture evidence of extremely high cerebro-spinal fluid 
pressure. 

As already stated. electrical currents produce varyingcfTccts 
upon the human body, according to the manner in which 
they enter. A dry skin is a bad conductor. With a low 
voltage and good contact the muscles are thrown into a 
state of extreme rigidity. It is this muscular spasm which 
renders it impossible for a man to relax his grip of a piece 
of metal charged with electricity. The e/Tects of electrical 
currents arc only experienced when the currents enter and 
leave the body, and not when the circuit has been closed. 
The making and breaking of the contact are the periods 
when there is danger. The pain felt by men in non-fatal 
electrical accidents is due to the violent muscular contrac- 




35« 



DISEASES OF OCCUPATION 



tloni compressing sensory nerves or to the action upon tJ 
nerve endings of the products of electrolytic decomposition. 

When an animal is mortally struck by electricity a cry is 
frequently tittered. The same occurs when a workman becomes 
the subject of a severe electrical accident. It U the cry that 
draws the attention of fellow-workmen to the spot whe^e lies 
the apparently lifeless body of a comrade. The face is pale or 
it is cyanoscd, the heart can no longer be felt beating or the 
pulse, the pupils are dilated, and mucus keeps oozing from 
the mouth and nose. Considerable care has to be exercised 
in removing the body from its contact with the Hve metal. 

One of the important facts revealed by my own and 
others' experiments is that while death in electric shock, in 
all or nearly all cases, comes from sudden arrest of the 
heart's action, yet immediate resort to artificial respiration 
will in many instances restore an apparently dead body to 
liTc again. This I have succeeded in doing on several 
occasions, and it has been shown by practice, in the case of 
workmen apparently killed by electricity, that once contact 
with the live metal has been broken nothing succeeds better 
in restoring men to life again than artificial respiration 
immediately begun, and continued until breathing is estab- 
lished, or for such a length of time as to leave no doubt 
that life is quite extinct. One of the dangers and difficulties 
to workmen attempting to rescue an injured comrade is that 
the live wire or cable may still be grasped by the hand of the 
victim, so tlut it~is dangerous to seize any part of the body, 
even the clothes, if they are damp. An attempt to remove 
the body of a workman suspended from the wires of an electric 
street lamp in Boston, [J.S.A., was the cause of the death of 
the rescuer. If the clothes upon the body arc damp there 
is always danger. Whenever any rescue work is being 
attempted indiarubber gloves should be worn, and if these 
arc not available the bands of the rescuer should be wrapped 
in thick dry rags before trying to pull the victim away from 
the cable or machinery. When removed the body should be 
placed upon it5 back, and while medical assistance is being 
sent for no time should be lost in putting artificial respira- 
tion into practice. Kneeling behind the head of the injured 




ELECTRICITY AND ELECTRIC WELDING 353 



l^aon, the operator should Rrasp the elbows and draw them 
II over the head, so 3s almost to bring them together above 
It, and hold them there for a few seconds; then, carrying 
the arms down and on to the chest, firm compression of the 
thoracic wall should be made, so as to displace the air in the 
lungs. The movements should not succeed each other too 
rapidly, but ought to imitate nature as far as possible. i.e., 
about sixteen times per minute. Stimulants shouki on no 
account be poured down the throat of the victim nor even 
placed in his mouth, [f life is to be restored at all, it will 
only be by artificial respiration carefully and methodically 
^■carried out, not too hurriedly, as already advised, and pcr- 
^■Ststed in for a considerable time — half an hour or even longer. 
^B After death In electric shock the blood is generally found 
^■dark and fluid, but occasiimally I found it clotted in the 
^' t^^t side of the heart. On spectroscopic examination the 
I Uood may be found to contain oxyhximoglobin and reduced 
I ha:m<^lobin. The lungs present nothing abnormal, unless a 
few ecchymoses if artificial respiration has been rather vigor- 
ously attempted. The pupils are usually dilated. The brain 
and spinal cord may be congested. There may or may not 
be marks of burns upon the body. 

The voltage used on railways varies from 300 to 600 
volts. This is allowed by the Board of Trade, the 
opinion being that it is not dangerous, but contact with 
lower voltages than these ha.s caused death on several 
occasions. In all cases the circumstances in operation at the 
time have to be considered. It is known that the risk to 
^^xailway men is increased in wet weather. The danger con- 
^Ksts in one part of the body, t^., the foot, touching the live 
rail while the oilier is on the wet earth. The elevated rail 

rnufrht therefore to be protected as far as possible to pnn-cnt 
idcnts taking place; 
Eieciric Wtiding 
in the electric weldir^ of metal, a method that is becom- 
ing extensively used in ironworks, the light produced is so 
intense that it cannot be looked at by the naked eye even 





ELECTRICITY AND ELECTRIC WELDING 

[a factory in Berlin where stect rails were fused by means of 
iftlcctrical currents. The work was being carried oo in the 
angle of a small court through which, on one particular day, 
thirty-two workmen had to pass. All the men felt more or 
less the influence of the clcctrica] currentt. On the following 
morning twelve of these men presented themselves for 
medical advice, as they were all suffering from "electrical 
ophthalmia." They had been awakened during the night 
by severe pains in the eyes, when they found their eyelids 
so swollen that they could hardly open them. There were 
photophobia and running at the eyes. On examination the 
conjunctiva was found to be red and swollen. In ele\'en of 
these men the cornea was intact, but in the twelfth it was 
slightly affected. The pupi! of the eye waa in each instance 
normal and reacted normally. The fundus oculi presented 
nothing abnormal, except that in two or three of the men 
the veins were slightly turgid and the paptlln: congetited. 
The acuteness of vision and colour perception were in no 
way aifected. 

In a lai^c works at Lamotte Brcuil, on the River Oisc, in 
which chloride of calcium is manufactured by the electrolysis 
of chloride of sodium and potassium, several of tlie work- 
men ha\'e suffered from an irritating form of skin eruption, 
characterised by a succession of crops of acne pustules and 
inflammatory nodules on the face, chest, and bguk of the 
trunk. The acne spots present a dark appearance, as if they 
contained grains of gunpowder. The colour persists long 
after the spots ha%-e disappeared. Dr. Fumouzc, who has 
described the malady, calls it " Dermatose chloriquc ilectro- 
lytique," and states that this form of dermatitis has been 
met with in Germany in men similaHy employed. The 
explanation of the cause of the malady which has been 
advanced by M. Jarackzcwski > is the presence of certain 
substances deposited on the electrodes, among which arc 
found one possessing strong oxidising energy, viz., chloranile 
or the tetrachloride of quinonc, the vapours emitted from 
which are extremely irritating. The chlorine vapour that 
is given off produces irritation of the skin, but there is 
■ Revue Scicnlijiqur, quoUd September tg. 1906. 



356 



DISEASES OF OCCUPATION 



apparently some other cause in operation, since Jt Is the 
who are cnf^&ged in the removal of the products of decom- 
position that suflTcr most The means recommended to 
overcome the dan^^ers are the immediate removal of the 
decomposition products from the electrolytic chambers after 
breaking up of the same in order to set free certain parts of 
the machinery once it has become cooled ; wearing of glo^'cs 
during handling of the products, frequent \vashing of the 
hands, a bath and douching before leaving work at the end 
of the day. Since putting into force these recommendations 
the malady has ceased to exist. 

Dr. Alfred C. Jordan,' medical radiographer of Guy's 
Hospital, has drawn attention to sterility among X-ray 
workers. It Is now admitted that azoospermia is produced 
by exposure to X-rays. If a worker has not taken every 
reasonable care to avoid exixjsing himself unduly to their 
action, he becomes sterile after working daily for a year or 
so. The wearing of !i]>ccially prepared protective aprons 
is recommended. The back of the hands of an X-niy 
worker whom I have examined arc swollen, tender, and 
cracked. So, too, arc the finger-nails. He gets relief by 
rubbing them with vaseline. Other serious effects have 
followed exposure to X-rays. One of Edison's experi- 
menters,'* named Dally, after suffering for six months frooi 
scattered patches of a painless erythematous redness of 
the skin like scalds, noticed that his hands were swollen. 
Although thus affected he continued to set X-ray machines 
in hospitals and colleges for two years, when the bums 
began to smart and to tingle and to be extremely painful. 
His sufferings were so intense at night tliat he was obliged 
to lie with his arras in iccti water in order to get sleeps 
Later on the left wrist became cancerous, and as the disease 
made rapid progress the left arm was amputated below the 
shoulder. Three months afterwards the little 5nger of the 
right hand became cancerous and had to be removed. 
Subsequently the right wrist was similarly attacked, and 
the arm bad to be amputated below the elbow. The respite 

' Bnttih M<dkat Journal, July 6, 1907, p. [5. 
• " Tbomas Alva Edisoa," by F. A. Joucs, p. 348. 




ELECTRICITY AND ELECTRIC WELDING 357 



' was of brief duration, for within a very few months Dally 
succumbed to the disease, which had become general. 
Although a martyr to a malady for which no cure was 
found, Daily's mysterious disease and rc<;rettablc death drew 
attention to the dangers of X-rays and to the absolute 
necessity of having the skin adequately protected. 

According to Dr. Alfred Haas, or Munich, a similar danger 
is said to exist among the Rontgen tube makers in Germany, 
In testing the tubes upon themselves the men have suffered 
1 from a severe form of dermatitis of the hands — the usual 
cRects being an acute inflammation of the skin followed by 
an eruption, at first vesicular and subsequently pustular, 
which frequently ended in ulceration not amenable to treat- 
it, or in gangrene. The Rontgen tube makers no longer 
the instrttments upon tliemsclvcs, but use the band of 
la human skeleton which is encompassed with gelatinous 
'material to resemble the hand of a living person. As in 
' England, atrophy of the testicles has also been found to be 
< one of the results of exposure to the electric rays. Of sixteen 
[workmen who were the victims of azoospermia (Brown and 
rOsgood : Archivts of RUntgin Rays, 1905), ail had been the 
fathers of families until they worked in Run^en rays, after 
which the wives of all the men became sterile. The sterility 
, continued for two yean after the men gave up the work. Jn 
IGermany the workmen protect their hands, face, and front of 
the body by large sheets of metallic lead. For the dermatitis 
alkaline lotions, oxide of zinc, and salicylic ointments have 
been found useful. 



CHAPTER Xin 

DISEASES THE CONSEQVENCE OF FATIGUE; OCCUPATIOX^ 

NEUROSES 

THE stress and hurry of modem life arc dcvclopir 
eflfccts peculiar to the age in which «■« live, Whilt* 
labour-saving machinery continues to increase there is yet a 
d<^rce of physical strain and iicrvc-tcnslon being experienced 
by the workers the influence of which cannot be ignored. 
The lightening of the burden of tlic textile worker by im- 
proved machinery has not altogether made mtll-vork easier, 
for by raising the speed and increasing the output a larger 
amount of machinery has to be tended, and this constant 
vigilance imposes a considerable strain upon the worker. If 
this is true of simple muscular movements necessitating only 
mechanical supervision, how much greater must be the strain 
and exhaustion upon persons who in their employment are 
obliged to execute a series of educated and rapid musculi 
movements in which volition is sustained throughout. 



Enghu-drivers and SignaltrUH 

arc, as a c!as.s. healthy men, They are all medically examn 
before given work under a railway company. The occupat 
of engine-driving is consistent with long life. En| 
drivers who have fixed passenger trains to look after hav^ 
regular hours. It is the men who are called upon at all 
hours to perform irregular work that suffer from the demands 
made upon their sleep and the opportunities of getting food 
and of eating it. Among this class dyspepsia b frequent ; 
for the food that is carried away from home ceases to be 

SSI 



FATIGUE AND OCCUPATION NEUROSES 359 



* 



attractive, and as it is occasionally far into the night before 
the men return it is often impossible for them to get a 
good meal. Diabetes prevails among engine-drivers to a 
considerable evtcnt It is double that of the standard. 
Many of them die from this disease between 50 and 55 
years of age. The malady is largely the result of the long- 
continued nerve-tension to which the drivers arc exposed 
Acute pulmonary complaints, too, are not uncommoa 
Pneumonia is more frequently met with than phthiius. The 
mortality from accidents is lower than in any employes in 
the running department. An engine-driver who has once 
been tn a collision, and whether the accident wa-s his fault 
or not, is subsequently transferred to the mineral traffic 
department of the railway company, a change of work which, 
white it may be meant as a solace to public opinion, is 
acutely felt as a degradation by the person concerned. 
Whether it is as the result of the shock, or in ccai- 
sequence of their altered position in the railway service, 
engine-men under these circumstances become nervous and 
never quite regain the self-confidence they possessed before 
the accident 

What is true of engine-drivers is, in the main, true of 
signalmen. Many railway accidents are the result of the 
too long hours and the continued strain upon the nervous 
system of the men. They arc overtaken by a kind of fear 
which paralyses them, or there is temporarily produced a 
degree of mental aberration. The chief causes of death 
among signalmen are diseases of the circulatory system and 
phthisis. 

In a Parliamentary paper, " Instances in which Eight-hour 
andTcn-hour Signalmen were on Duty on the Railways of the 
United Kingdom for more than their Uookcd Hours during 
the Month of February, 1906," it is stated that the total 
number of instances shown in the return of one raihvay com- 
pany alone was 617. In 4.30 of these instances the late 
working was due to the absence, through illness or other 
causes, of the men by whom the work should have been taken 
over at the end of ten hours, and the impossibility of obtain- 
ing relief owing Co the short notice. In 162 instances the 




360 



DISEASES OF OCCUPATION 



overtime was worked, chiefly on Saturday night, to pass 
late train. The total number of instances in the United 
Kingdom of eight-hour signalmen being on duty for more 
than their booked hours was 2.226, and of ten-hotir signalmen 
being on duty for more than their booked hours the total 
was 9,512. These returns refer to the 9,164 signalmen wh 
are eight-hour men, and 9,721 ten-hour signalmen in the 
United Kingdom. 

It is unnecessary to dwell upon the strain necessarily felt 
by an engine-driver who is driving an express passenger 
train on a long journey. No sooner has he passed one 
signal than he is on the outlook for another, and as a con* 
sequence the nerve-tension is kept up all the time, it is not 
alone a question of observing signals, but also of attending 
to Uic rate of the running and its bearing upon the manage- 
ment of his engine. Fiimishcd with a time-sheet on which is 
stated the second at which he ought to pass every station and 
every important signal-box, he is obliged to record on this 
sheet the actual time of passing. As a counter record is kept 
by the guard of the train and the signalmen, the work imposed 
upon the engine-driver i.s greater than most people imagine. 
There is nothing to indicate that the speed at which these 
men run their trains makes them careless of the dangers they 
have to avoid or heedless of the freight entrusted to thera. 
On long-distance fast trains the fireman is also extremely hard 
worked. He is stoking nenrly the whole way. Coal has to j 
be shovelled into the firebox at the rate of two tons per^| 
hour. Seeing that there is imposed a severe strain upon the 
engine-driver and that the stoker is also fully employed, the 
question has frequently been asked, in view of the possible 
sudden illness of one or other of the two men, as to the 
advisability of having a third man on the engine. This is 
a question which railway experts alone can answer, but 
which in fairness to the public ought to be seriously con- 
sidered. 

Writer^ Palsy: Scrivener^ Spasm 

One of the consequences of the ofi-rcpcatcd use of the pen 
carried on for months and years is the development of ■ 



FATIGUE AND OCCUPATION NEUROSES 361 

peculiar spasm of the finger<:, whereby, when a person is 
writing, the hand becomes unable to execute the comtnantls 

lof the will. Writing is an act learned by education : it never 
becomes automatic Attention must be concentrated to a 

I greater or less extent when writing. In scriveners' spasm 

Ithc fingers during the act of writing become the seat of 
painful cramp, which makes it impossible for them to complete 
tiie word begun. Although in one sense the result of some 

' defect in the function of the muscles and nerves concerned, 
it is more than probable that a central cause is in operation 
as well, and that there is fiitigue of the brain as well as of the 
small muscles of the wrists and fingers. A long rest and 
abstinence from work may restore healthy function to the 
muscles of the hand, but even after a lengthened rest it is 
not uncommon for spasm unexpectedly to occur. This is a 
serious trouble to persons, such as clerks, who have to earn 
their living by copying, &c. There is not the least doubt 
that it is this circumstance and the long required rest, with 
the sense of impending poverty, that makes recovery so slow 
in the majority of these cases. When the spasm and the loss 
of power are well marked it is advisable to train the muscles 

jof the other hand to execute the necessary movements, or 

ffor the individual to take up some other work, such as typing 
instead of writing. The possibility of writers' palsy occur- 
ring in those who have to use the pen for several hours every 
day raises the question incidentally as to whether it would 
not be well to encourage the study and practice of ambi- 
dexterity in our schools. By ambidexterity we might be 
able to ob^-iate some such troubles as these just mentioned. 
Writers' palsy ta certainly best got rid of by inducing other 
sets of fresh muscular movements. The intemperate use of 

1^ alcohol and tlie excessive use of tobacco favour the develop- 
leot of fatigue neuroses and retard recovery. 



Typists and TeUgraph CUrks 

"are liable to similar troubles to those just described ; so, too, 
are pianoforte players. Mai WUgraphtgue, or telegraphists' 
spasm, was first described by Onimus, a Frenchman, in 1875. 



362 



DISEASES OF OCCUPATION 



Thirty years ago the malady was rare, but in the succeedit 
ten years many cases were recorded. It is met with mostly' 
in those who use the Morse instrument. The Morse alphabet 
is composed of a series of dots and dashes, and the messages 
have to be quickly transmitted. Females do not appear to^ 
be more predi.sposed to the muscular spasms than male 
Telegraphists who have suffered are prone to becoc 
depressed mentally. A long holiday should be 
upon and ambidexterity encouraged. 



Trap- Drum fiurs' Nturosis 

In the Medical hJews, February 7, 1903, Dr. Oiarl 
Aldrich, neurologist to the Cleveland General Hospital, 
Ohio, draws attention to a hitherto undescribed scries of 
symptoms occurring in a man who had followed for twenty 
years the occupation of a trap-dnimmcr. Besides being 
obliged to practise, he had to play twice a day in a theatre 
The work was heavy and required great rapidity and 
strength. The drum had to be beaten by the operation 
of a pedal manipulated by the right fooL This gave him 
the use of botli liands to play the other drums, triangle, and 
the various traps, hence the name of trap-drummer. Hb 
illness began with cramp-like pains and a feeling of exhaus- 
tion in the muscles of the right leg below the knee, and was 
accompanied by a sense of constriction of the leg as if the 
circulation had ceased. This wa.i followed by burning pains 
in the knees when he began to walk or use the leg in beatii^. 
It required a pressure of 5 to 25 lbs. for each stroke to play 
the drum and a rapidity of movement equal to IJO to 180 
strokes per minute. This always brought on a severe pain 
in the knee, and at the end of the performance the leg fdt 
numb, heavy, and useless. On examining the right leg and 
foot which did the work, they were found to be better 
developed than the left 1^ and foot, but the muscles were 
thrown into a state of painful cramp when the movements 
required in beating the drum were made. It may be said of 
all occupation neuroses that the muscles which are liable to 
become affected by paralysis and painful cramps arc those 



FATIGUE AND OCCUPATION NEUROSES 363 

which arc called upon to perform almost continual!/ niove- 
mcnts that are the result of volition and sustained mental 
attention — movements, in a word, that cannot be relegated 
to automatic or excito-motor centres in the lower brain and 
spinal cord. Hence motion and sensation both become 
affected. It was only when Aldrich got the patient to 
educate htrasclf to use the left instead of the right foot that 
progress towards recovery was effected. 

It is astonishing how the exercise of certain muscles 
leads to hypertrophy of these muscles. In a Punch and 
Judy man who was an in-patient of the Royal Infirmary 
I found the muscles of the forearms and hands, but espe- 
cially those of the thumbs, enormously developed and 
extremely strong compared with those of the other parts 
of the body. He told me that 011 several occasions on a 
Saturday evening, when some man in the crowd had inter- 
posed his arm between the dolls, he would bring down the 
wooden bSton in Punch's hands with such force as almost 
to break the arm of the intruder. The muscles of the thumbs 
and forearm had become overgrown through use. It is well 
to remember that over-employment can even affect hyper- 
trophicd muscles, as illustrated by the painful affection known 
.as "hammermen's spasm." 

It is unnecessary to multiply examples of fatigue neuroses. 
Violinists suffer equally with pianoforte players. Seam- 
stresses arc similarly affected in their hands, so loo are 
type-setters. The cowherds In the Tyrol are said to suffer 
from milkers' spasm. All persons following occupations in 
which quickly repeated muscular movements with con- 
centrated mental attcndon arc required are liable to the 
painful cramps mentioned above. 



School Teaching 

The demand for education has created opportunities for 

^an increasing number of young girls to take up teaching as 

a profession. To many girls the strain of preparation for 

becoming pupil teachers is too great ; they break down 

entirely in their nervous system, while in the case of others 



3^4 



DISEASES OF OCCUPATION 



the confinement in school is a cause of ansemta, and 
inability to sit and obtain rest during the menstriu) 
periods is productive of pain and uterine displacements. 
Apart from these, the vocation of the female teacher is 
not unhealthy, so long as the schoob are well ventilated 
and are not overcrowded. When the air is close and tbe 
classrooms too full, headache is experienced by many of 
the teachers. As pulmonary phthisis occurs in school 
teachers with greater frequency than in members of the 
other learned professions there is not the least doubt tliat 
the malady is caught in the school or tbe conditions of 
school life arc such as to reduce the vital rcsititance o 
the individual and render him more liable to disease. 
As tuberculosis is an infective disease, and frequently the 
result of inhaling dust to which the specific bacilli arc 
adherent, this raises the question as to the best means of 
ventilating schools and of laying the dust of schoolroom 
floors. The sweeping of floors should never be done in 
the morning before school hours— alwa}'s after, and before 
being swept they ought to be sprinkled with some such 
antiseptic liquid as a solution of carbolic add. Children who 
are known to be the subjects of tuberculous lung disease 
ought not to be allowed to attend the ordinary schools, nor 
should the attendance of children with open tuberculous 
sores be encouraged unless the wounds have been dressed 
antiscptically. 

As a consequence of giving lessons in singing over a long 
period young school teachers occasionally become hoarse 
On examining the lar)'nx minute nodules, smaller than grains 
of semolina, may be observed on the vocal cords. Under 
complete rest to the voice, speaking only when necessary 
and then not louder than a whisper, recovery usually takes 
place. School teachers would act wisely if they did not use 
dry cloths to remove the chalk markings on the black- 
board, since inhalation of the fine dust in many instances 
is followed by irritation of the lining membrane of the ihroaL 

Young school teachers who have not had the ordinary 
infectious ailments of childhood run the risk of catching 
these during epidemics in schools. 



•^ 
t 




FATIGUE AND OCCUPATION NEUROSES 365 

Domestic Servants 

Domestic servants as a class supply a large contingent of 
patients to infirmaries. The " general " servant has often 
a hard life of it, owing to long hours, insufficient and 
improper food, and the want of proper sleeping accommoda- 
tion. A lai^e number of domestic servants become anxmic. 
Many of them sufler from dyspepsia and ulceration of the 
stomach. In a few the ulceration is followed by vomiting 
of blood and sudden perforation of the wall of the stomach. 
As a consequence of being too many hours on their feet 
some of the older servants suffer from varicose veins of 
the legs, while owing to confinement indoors headache and 
constipation are frequent complaints among all who are pre- 
disposed to aoEemia. 



CHAPTER XIV 



IN MtSCELLANEOUH TRADES AND OCCUrATIONf 



Tea Tasling 

MEN employed aa buyers and sellers in the wholesale 
tea trade, and wlio arc therefore required to t&ste 
several .•iamplcs of infused tea daily, frequently su^er from 
dyspepsia and insomnia. The infused beverage is seldom 
swallowed, the mouth is simply rinsed with the liquid ; but 
as this is repeated several times in one day tea tasters 
frequently suffer in consequence from uneasy sensations 
in the stomach after food, flatulence, loss of appetite, and 
conalipation. Their ner\'ous system, too, becomes unstrui^. 
Tea samplers suffer from nervousness and irritability, also 
from loss of sleep. In some instances there is emaciation 
and discoloration of the nails. The effects of tea tasting 
and immoderate tea drinking differ from those of alcohol in 
so far as the symptoms arc mostly functional. If the 
intemperate use of alcohol is carried on for a long time, 
structural changes are set up in the liver, kidneys, and 
nervous system, which may lead to death even after 
indulgence in alcohol has ceased, but there are no similar 
organic changes induced in the internal or^ns as the rcsalt 
of the excessive use of tea. A patient has only to give np 
taking tea, when he begins to improve and his symptoms 
to disappear. When therefore tea tasters begin to suffer 
in the manner already mentioned, they ought at once 
to renounce the practice for a few months. There is an 
idiosyncrasy to tea. Some persons can follow the occupa- 
tion of tea tasting without experiencing any ill effects. 
Those who cannot do so ought to renounce this particu lar 
part of their du^. 



MISCELLANEOUS TRADES 



3<i7 



Fish Curing: Herring Salting 

Allusion is made elsewhere in these pages to the risks to 
life and the dangers incurred by fishermen when plying their 
calling. Out in all sorts of weather and exjKksed to sudden 
squalls, their occupation is attended by considerable risk. 
Ic is of the curing of fish that I would speak, and especially 
of herring. This Ls an important industry. According to 
the Report of the Scotch Fishery Board. go,ooo Scots are 
employed in the various branches of sea fishing, of whom 
one-fourth are women, and these follow the occupation of Ssh 
curing. The perishable nature of the product and the 
unexpected appearance of shoals of herring at certain places 
render the trade peculiarly uncertain, and oblige employers 
to proceed at once with the cleaning and curing of large 
hauls of herring. As the herring migrate round the const of 
Scotland and down the East Coast of England, the fish are 
followed by a fleet of boats and an army of male coopers and 
female curcrs, and as the migration occurs during the summer 
months, when in Scotland the days arc long, the work is 
frequently carried on well into midntghL In the months of 
May and June the herrings arc found at Stoinoway and 
Thurso, but by July the fish have moved onwards to the 
Shetlands, Wick, Fraserburgh, and Peterhead, and for a time 
these arc the centres of the herring industry. Later on in 
the autumn the move is southwards, to the Yorkshire and 
Lincolnshire coasts, so that by October, Lowestoft and 
Yarmouth are the principal scats of the industry. During 
the summer months, when the weather is dry and fine, little 
can be said against the surroundings of certain places where 
,liie work is carried on. The hours are long and the work 

I necessarily attended by a considerable amount of physical 
fatigue. For the best accounts of the herring industry we 
must turn to the Reports of the I-ady Inspectors of Factories 
which are published in the Annual Reports of the Chief 
Inspectors of Factories and Workshops. The importance of 
the herring harvest is not realised until a visit is made into 
the far north of Scotland, when it becomes at once apparent 
how the industry affects the wcllbcing of thousands of 




faS^ 




^UEBT"1D IK tBl^S) 3D . 

I'lnii^ s ^jj"p aad CBMfimcd to' 

3D nlC^n^K. 

> i i^i i " V I i Hii i iw ^ and lAnfe •^n ■■ s a i iiiii ii i t ' "*^^ »— ■■* j 
jttpdriiitjf' amnnE fliciit, ftcfc 3E Blflc ""*"''* ""^f^'^j of Ac 

wuaes. *^™"' act ai^nBES Id '*^ ". ano 

Aii=r haxinr; vrapped bandog* t p ui ii! Ai ^mg ri ^ flat bc 
mas: iicE^y n. bt ininr^ br 3iir cnives, tie frTmW gnneis. 
liBriiig Q3img£ hif^ b3DC£. walcinuiE sara. xad a tUd 
ccsc pnggsc. tr> "nt-- wart: cf cJSBniiir anc ^ihn^. Two 
E H t i ~ r ' anc ant pa-c^ consmiit E ^ zrew,'" Amnog' Ac 
u g wi -jir^ if- L CDnsidsahJE amDurc nf TTcary. anc as Ac 
furanr ani ia=ong ^T frssfc faarr i ng come miiisr the exc^- 
tior. af uniimiisL hours p-rmraEC br tbc FactaTT Act. Ac 
itti^izjJ n^v'sr? nf 'Hie ucwi- whz are cnmncmf vidi otft 
cnb=r mEv bE33mt f^rhaii^sd. Th; baas tiKi, came in at 
rr-riiiii: hnur^ rnnaeauentjy its: e5 nm:± □:' ilic work mar 
ta^'t i; b; naitt bETv-ssr nigin ami mD-nin^ as durii^ ibe 
day ly vmunr is^it or. rianirCET- rvmini: and cominsncing 
afaii. BZ minnirb: 3r fiunday tiif W£jrk=r= usualh' """Trri in 
g f -'TTir ^bt Sundz;. f tss:. It i? rht in^iuar nanne of the 
wuTH ant: tbf iiaif hong tha: try the health of the gnnes. 
OccBsionaSr luy have nn&s^ to drhirdns : at . 
thf^ k SD pos^uii^ of gesth^ losmc. Add to Ac 



MISCELLANEOUS TRADES 



369 



" tow: 
ton 



rs the insanitary condttionn of the surroundings, the wet 

ound on which the women are standing exposed to 

clement we&ther, shortAge of sleeping accommodation. 

difficulty of obtaining proper food and time to cat it, and 

it is small wonder that, strong and healthy as the women 

at the commencement of the Bsbing season, they are 

towards the end of it frequently crippled in health. Some 

idea of the imperfect housing accommodation may be Icajncd 

trom the fact that in some places the sheds used in winter as 

stores are utilised as sleeping-rooms in summer, one bed 

bang provided for each crew. As a consequence of the 

arduous work, long hours, exposure to weather, and the lack 

of healthy sk-eping accommodation the vital resistance of the 

Women is reduced, so that many of them on reaching home 

arc found to be suffering from pulmonary disease or become 

tsubi^equently the subjects of chronic rheumatism. 
There are risks incurred from the use of the knife in 
gutting the herring, also from the stings inflicted by the 
jelly-fish which often adhere by their tentacles to the fish. 
Although the fingers which are liable to be injured are 
usually protected by bandages, yet wounds are often acci- 
dentally self-inflicted. Owing to the nature of the work nnd 
1 the difficulty of keeping the wounds clean the broken skin is 
^frftpt to fester and the cuts to heal slowly, conditions which 
^vexpose the women to the possibility of blood-poisoning. 
^vThcse are risks to which the gutters as a body are exposed, 
yet fortunately few of the women become ill from this cause. 
In addition to the overcrowding and insufficient hut accom- 
modation the women complain of the deficiency of sanitary 
conveniences. There is not the privacy for the women that 
there ought to be, either at the curing stations or near their 
huts, nor is there always an adequate supply of pure water 
^frfbr drinking purposes and washing. As the industry is a 
^Bprofitablc one, employers should h<t obliged to iiay more 
^rattcntion to the requirements of female workers and should 
be compelled to provide proper sleeping accommodation 
and easily accessible sanitary conveniences, and, whenever 
possible, not to extend the hours of work beyond the limits 
f a reasonable working day. The evil effects of the work 




370 



DISEASES OF OCCUPATION 



are not always in evidence during the busy seasoi 
later on when the women, having returned to their homes, 
exhibit the signs of physical fatigue and of disease which 
may be permanent. Were it not for the fact that the 
women arc strong and healthy at the commencement of 
the season and are generally above 20 years of age, there 
would be a greater amount of ill-health to record. 

Younger girls, e^., under iS years of age, arc employed in 
the curing and smoking of haddocks, also in the preserving 
and tinning of fish, but these girls live at home owing to the 
industry being purely local. The surroundings in which the 
work is carried on are not always good. The hours, too. are 
long and are particularly trying to growing girls. If the 
hours of work were better regulated, the curing and smo! 
of lish would become a healtiiier occupation. 




Fruit Preserving 

The cheapness of sugar and the increasing inexperience 
and helplessness of many of the wives of the working classes 
as regards cooking in all its branches, are creating 3 growing 
demand for factory-made jams. The art of prescr\*lng fruits, 
of making sweet cakes, and of baking is declining as a 
domestic pursuit in most part» of the country. To meet 
this attcmpu are being made by municipal and other 
authorities to instruct the rising generation in cookery. 
Ignorance of cooking on the part of the wives and daughtcn 
of the artisan and poorer working classes is responsible foe 
much of the domestic discomfort, also for the poor physique 
of some of the children of to-day, and the vrasteful extra^'a- 
gancc in many a home 

Many of the places in which jam is made in this country 
ought not to be allowed to exbt. Some manufacturers arc 
of the o[Mnton that any building is good enough for their 
trade. Consequently we find Jam factories in courtyards 
contiguous to stables and even more objectionable buildings 
and with no attempt made to provide good Sooring or 
satisfactory ventilation. On the other hand, several of the 
jam, chocolate, and confectionery factories which 1 have 



MISCELLANEOUS TRADES 



37 » 



visited at home and abroad arc models of cleanliness. There 
is no reason why all jam factories should not be such, for if 
I the British public only saw some of the places and knew how 
preserves were made it is questionable whether the taste for 
bought jams would be as widespread as it is. Fortunately 
(the old type of factory is disappearing. 

There is neither any difficulty to be overcome nor any 
intricacy of process to be observed in the making of pre- 
serves. Much of the work can be done by unskilled labour. 
Machinery is in use for the removal of the stones from 
I stone fruit. What arc essential in a jam factory are cleanli- 
ness and attention to minute details. The woric is not light, 
^and yet many employers hesitate to introduce labour-saving 
iinery. By young persons weights have to be carried 
that are beyond their strength, and owing to the slippery 
State of the floors falls are frequent. Bums and scalds from 
the boiling mixtures arc not unknown. There is a relaxation 
of the Factory Act which allows of overtime being worked 
^dnring some of the summer months, and in consequence of 
there is a tendency for employers to overwork the 
[younger hands especially. To some extent this might be 
rprcvented by the fruit being cleaned before it is sent to the 
'factories, and with the ready means of conveying information 
by telegram between the growers of fruit and the pre- 
serve manufacturers, there need not be the sudden and 
unexpected arrival of large quantities of perishable fruit 
towards the close of a working day, which, if it is to 
be boiled at once, will necessitate overtime. 

With judicious supervision the excessive moisture in the 
boiling-rooms can be restrained, and considerable discomfort 
and injury to health tliereby prevented. The removal of ex- 
cessive steam is desirable owing to its chilling effects upon the 
'Workers, many of whom are thinly clad, are anaemic, and of 
•poor physique. In tlie large towns the girls arc not always 
[drawn from the best classes of workwomen. They are ill-shod 
|as well as badly clad, and as they have to stand for hours 
' on wet floors, chilling of the extremities and the long shifbi 
lead to functional and structural derangement of the pelvic 
:>rgans, and lay the basis of female disorders and displace- 




yjz 



DISEASES OF OCCUPATION 



mcnts. During the spurt in the trade in the summer mon' 
the work is fatiguing ; it is practically continuous, th«fe betfi; 
little time for rest atid meals. These conditions Home Office 
Rq^lations have already materially improved. The evil 
effects of working long hours in jam factories may not show 
themselves in female workers until after long service therein, 
or after the women have given up the factory altogether. 



4 



^ 



Label Lukittg 

Formerly much in vogue in thread mills and in industries 
connected with the sale of small packets, label licking fortu 
natcly is falling into disrepute On the occasion of my vtut 
to several factories xvhcrein the practice was carried on it was 
not uncommon to see young girls sticking labels on bobbi 
after having licked them. In many instances Che effect 
this practice was the development of enlarged glands in the 
neck and small sores on the tongue. The coloured labels 
often contain copper and lead, and had it not been for the 
varnish on tlic labels being of some resistance, there might 
have occurred metallic poisoning as well. Apart from this 
risk, the adhesive agent on the labels is occasionally obtained 
from unhealthy sources. While the gum may be normal, the 
water made use of to dissolve it may not be pure Besides 
it is not gum but a substance of an animal nature, a 
serum, ttiat is sometimes employed. To the use of this scrum 
and gum must be attributed the malady known as " stamp* 
ticker's tongue," in which small ulcers are found on the tongue 
and inside of mouth. From these ulcers septic material may 
be conveyed to the submaxillary glands in the neck, and 
induce in these and adjacent glands an acutely painful 
inHammation. Although the ulcers in the mouth are readily 
cured by antiseptic washes and constitutional treatment, 
label licking is a nasty practice which ought to be prohibited, 
not simply on account of the risk of septic affection, but of 
the great sacrifice of saliva it entails upon young girb at on 
age when they require tlic secretion for digestive purposes- 
Tbe quantity of saliva lost to the system may be gauged by 
the fact that half>timcrs will lick as many as IbrCy to fifty 




•MISCELLAXEOUS TRADES 



373 



gross of labels in one day, and an adult woman ninety gross. 

■ Mechanical contrivance:; exist for putting on labels. 

In the thread millA of Scotland special power-driven 

Imachincs are in use for labelling reels of thread. It is a 
matter of regret that in several of the large mills in England 
manufacturers seem unwilling to put an end to the insanitary 
method of effecting the labelling by means of the tongue and 
saliva of girls. Miss Squire, H.M. Inspector of Factories, 
recently found in one factory forty little gii"ls, twcnty-onc 
of whom were half-timers, employed in labelling reels of 
sewing silk and skeins and balls of embroidery silks. All of 
them were moistening the adhesive labels by the mouth, 
sometimes to the number of thirty gross a day or more. The 
tongue of each girl had the polished tip characteristic of 
label licking, while the remainder of the tongue was brown 
from the gum. Some of the girls complained of the gum 
tasting nasty and of making them feel sick at times, others 
complained of feeling thirsty. One woman bad sores on her 
lips, which, while possibly a consequence of the work, presented 
a breach of surface through which infection might enter. 
Employers occasionally complain that where dampers have 
been provided the employ^ refuse to make use of tliem. 
In Leek, Staffordshire, a centre of the silk thread industry, 
there are 250 women and girls who earn their living by 
licking labels. The girls, who are paid on piece, can get 
through 30 to 40 per cent more labels than those who use 
the dampers. This circumstance explains why dampers arc 
not used. The work is badly paid. Few giris make more 
than 2s. to 3s. 6d. a week. 



Sugar Rtfining 

The manufacture of beetroot sugar is less a British than a 
continental industry. In sugar factories the men who are 
employed to stir the molasses, also those who work at the 
refining processes, occasionally suffer from sktn eruptions 
which pre^'ent them following their occupation. There is an 
affection known as the "lymphangitis of sugar makers," but 
this inflammation of the lymphatic vessels is not a serious 



DISEASES OF OCCUPATION 



matter. At the outset the lymphangitis is attended by^ slight 
fever and loss of appetite. If the workman continues to follow 
his employment, there may occur a crop of boils, the skin 
around which is hard and indurated. Occasionally the boils 
suppurate. Within a fortnight the workman in able to return 
to the factory. It is interesting in connection with this to 
rememtxr that patients who are the subjects of diabetes and 
who arc passing sugar in their ur Jnc also suffer from boils. In 
the case of sugar makers it is more than probable that the 
niicro*or^anisms of the atr and water settle down upon the fine 
hairs of the skin, and through the follicles gain an entrance 
into the skin itself. The sugar itself seems to exercise some 
local inHucncc, for it may act upon the blood, and thus, a^ in 
diabetes, predispose to the formation of boils, eczema, and 
ulceration of the skin. A scries of experiments carried out 
by M. Gaillot « at Aisnc has shown that tlie lymphangitis of 
sugar makers is caused by an organism, the Stafikylatwau 
pyogenes aureus, and that this micro-organism is not found 
in freshly-made molasses, but is met with in the residue, and 
that the temperature of the factory and the condition of the 
skin of the workpeople arc both favourable to the develop- 
ment of the micr^K. During the multiplication and growth 
of the Staphyhcotats pyogeua annus tlie micro-organisms 
produce fatty acids by transforming saccharine material into 
lactic, acetic, and butyric acids, while virulent toxins 
formed as well. These soluble poisons along with the micro- 
organisms may penetrate the skin by the hair- follicles. 

The treatment of the skin affection coiuists in bathing the 
skin with such antiseptic and germicidal solutions as mercury 
|jcrchIottdc or carbolic acid. In the newer procc^^scs of sugar 
manufacture in which mechanical methods have supplnntcd 
hand labour boils are not so frequently met with among the 
workmen. 



UIO I 

TO-™ 



Manu/acturf cf A<raUd Waters 

The manufacture of aerated waters is a dangerous industry, 

for owing to the pressure under which the bottles are filled 

accidents arise through breakage. The bottles when they fly 

* BulUhm de tltuf'tclton du Travail, 1903, Not. 3 and 4, p. 197. 



« 




MISCELLANEOUS TRADES 



37S 



I 



produce serious wounds, for these are usually deep and 
blootl-vcsscis arc frequently severed. Until recently the loss 
of at) eye was not an uncommon occurrence in aerated mineral 
water works. Since the introduction of face-guards and 
gauntlets the number of accidents has been materially 
reduced, bottlers, wircrs, sighters, and labcllcri arc all 
alike liable to be injured unless protectors are worn. The 
bottlers are most exposed to danger. The bottles often 
burst in the machine with considerable force and fly great dis- 
tances, occasionally inflicting serious injury upon workpeople 
several feet away. Bottling is done both by men and young 
women. Wiring has gone out greatly since the introduction 
of patent stoppers. Sighters examine the filled bottles by 
holding them up to the light to sec if any specks are present. 
Sighters and iabcllcrs often discard the protective wire 
gauze face-guards and gauntlets. The sighters say the face- 
guard interferes with their proper obscr^-ation of the bottles, 
and the labellers dislike the gauntlets, or woollen mittens, 
because they interfere with the rapid handling of the bottles. 
If the face-guards arc made of light wire and do not press 
too closely upon the face, but fit comfortably, there is less 
objection raised to ttiem, but if they are at all heavy or of a 
clumsy make the workpeople refuse to wear them. Alt 
persons employed in an aerated water works are exposed to 
the risk of bottles bursting and flying tlirough the workroom. 
The other dangers incidental tu the trade arc standing in the 
wet and working in wet clothes. In mldition to wearing* the 
protectors above mentioned, splashboards should be provided, 
also waterproof clothing and clog5 for the fccL 



Giass Making 

Glass is made from 5ne sand that has been carefully dried, 
and is known to be free from iron. The sand supplies tlie 
necessary silicic acid. To it soda, salt, lime, felspar or 
quartz, and according to the colour wanted, red lead, black 
oxide of manganese, nickel, arsenic, or copper are addc»]. 
Boric acid may be substituted for silicic acid. The sub- 
stances when mixed arc melted in a circular furnace at an 



MISCELLAMEOUS TRADES 



377 



Glass makers suflTcr at times from the cflTccts of the great 
It and exposure to rapid variations of tcmperatHre. Bron- 
chitis and pulmonary diseases are common among them. 
In the Miinch. Med. WochenstM., 1904, Prcttin and Licbkind 
discuHS the subject of the pulmonary emphysema of glass* 
blowers. Physicians who attribute emphysema of the lungs 
to mechanical causes gcr>crally allude to instances of the dis- 
ease in men whose occupations require powerful respiratory 
efforts frequently repeated, e^., players on wind instruments, 
glass-blowers, &c., but Fischer did not find one single case 
of pulmonary emphysema in five hundred army musicians 
whom he examined. My friend and teacher the late Sir Wm. 
Tennant Gatrdner, in his lectures on the causation of pul- 
monary emphysema, used to tell his class of the absence of 
emphysema of the lungs in well-known bagpipe players. 
Prettin and Liebkind examined 330 glass-blowers, of whom 
218 were from 25 to 50 years of age, also iz glass-blowers 
^ed from 50 to 62. All had worked at the trade for more 
than twenty years. The numbers were loi for more than 
thirty-one years, and 24 for ten years. Of these 230 work- 
men there were only 5 who were suffering from pulmonary 
emphysema. One hundred and sixty-four of the men aged less 
than 40 years did not furnish one single case: of 54 men 
from 40 to 50 years of age only 2 were attacked, and of 12 
^ot^ than 50 years of age 3 presented physical signs and 
"* symptoms of emphysema. Using pneumatomatic methods, 
these observers found ihat the intra- thoracic pressure in all 
I glass-blowers is greatly increased. Notwithstanding this 
fact tlicy maintain that glass-blowing docs not produce 
pulmonary emphysema, and that when it docs occur dis- 
crimination should be made between the distension of the 
alveoli of the lungs caused by repeated respiratory efforts 
and the same condition induced by inhalation of dust and 
the frequent colds and bronchitus to which glass-blowers are 
subject Cough alone, according lo I'rcttin and Liebkind. is 
I not of itself causative of emphysema of the lungs. Although 
^■According to their statistics emphysema in giass-blowcrs is 
^^ uncommon, their inquiry shoived on the other hand that pul- 
monary tuberculosis is met with in glass-blowers to the extent 




378 



DISEASES OF OCCUPATION 



of 30 per cent., part of which they attribute to the unhealthy 
condition of the trade and to direct conUgion by the blow- 
pipe which is in use being passed on from one workman to 
another. 

As there is usually a great amount of dust being blown 
about in the neighbourhood of the furnaces the eyes of the 
workmen occasionally become inflamed. Glass-blowers should 
have and should use their own blow-pipcs and not take them 
up indiscriminately, owing to the possibility of tubercular and 
syphilitic infection. The men who use the blow-pipes are 
liable to "glass-blowers' mouth," a condition to which Dr. 
Schulc, of Berlin, drew attention, and in which lai^ swellings 
like air-cuahions appear on the cheeks, extending from the 
angle of the mouth to below the cars. The swellings look 
like mumps, and involve the parotid gtand. They crepitate 
under the finger, and by pressure can be made to disappear. 
This relaxation of the cheeks is by some writers attributed 
to faulty blowing. I have met with this facial deformity in 
glass-blowers in Newcastle, but it is not of common occur- 
rence in the North of England. Dr. Schulc found it present 
in 2$ per cent, of the men employed. The deformity is due 
to air under high pressure entering the duct of the parotid 
gland, where it opens into the mouth inside the chc«k, and 
where thick pale patches of hardened mucous membrane 
can be seen — plaques opalirus — which Guinard regards 
as the result of the great straining and pressure the buccal 
mucous membrane is exposed to during the act of blowing. 
In the course of one day a good workman will blow as many 
as six or seven hundred bottles. This is an indication of 
the strain the men are exposed to, and from which, in 
addition to the deformity just mentioned, the men suflfer 
from deafness consequent upon the increased internal pressure 
in the middle car. Many of the men, owing to the peculiar 
manner in which they grasp the iron blow-pipe, suffer from 
a deformity of the fingers known as main en crocket. In the 
new methods of glass-blowing the blowing is not done by men 
but by machinery. Compressed air is driven into the glass 
by machinery, so that instead of a man being able to throw 
off only 40 glass tumblers in an hour, i machine worked 




MISCELLANEOUS TRADES 



379 



by 4 men and 7 boys can by the new method throw off 
500 in an hour or 5,000 in a working day. The substitution 
of compressed air will do much to remove many of the minor 
ailments glass-blowers have sufTcrcd from. It is also more 
cleanly and hygienic. 

There is one other malady glass workers are subject to 
and to which attention must be drawn, and that is the risk 
to the men of losing their eyesight from cataract The 
statistics of ophthalmic surgeons in regard to the frequency 
of cataract in glass workers are somewhat at \-arianoe, but 
from figures supplied by the Yorkshire Bottle Trades' Union 
it appears that out of 1 14 cases of men on their superannua- 
tion fund 37 went on the fund on account of cataract* It is 
■believed that the crystalline lens of the eye in glass workers 
becomes more frequently opaque than in men following other 
occupations. Dr. Probsting, an oculist in Cologne, found 
cataract present in 12 percent, of the factory operatives in 
Ehrcnfeld above 40 years of age, and Mcyhofcr in i J'6 per 
cent, of 506 glass workers. In Sunderland there are 400 men 
employed in glass factories. Dr. Wm. Robinson, of that 
town, informs mc that 48 of these men have been operated 
upon for cataract It is the furnacemen, or those who are 
exposed to the great heat and light, who suffer most. 
]k)tilc-makers have to look into large tanks filled with 
molten material, the temperature of which is often 2,5000 P. 
Robinson finds that the cataract commences in the posterior 
pole of the lens, and Hirsch is also of the opinion that it 
begins in the cortical layer on the posterior wall of the 
cr>'stallinc lens. According to Cramer « it is the left c)* 
that is the more frequently aflcctcd. The workman usually 
stands with his left side to the furnace, the left liand sup- 
porting the blow-tube, which is held and directed by the 
right The change in the lens proceeds so slowly that it is 
' not until months or years have elapsed that the men consult 

' Through Ibc kindnvs-t o( Ur. Alfred Greenwood, S«:reliirj of the 

''CUss Bottle Makcib. oi Yorkshire United Trade Protection Society, 

I nm nhic to slate Ihnt Mncc these figures were published other 85 cases 

tuvc been added to the lupcranouation fund, making a total oj 199, 

aitd of tlivsc i:t5 cases 1 5 were placed on the fund on account oS cataract 

* A'/nt. Mott4itibl3tlrr f, Aug^oikdlk., January, 1907. 



jfc ixs£AS£s OF occz^xryis 



i. O'xs.tc 3C*7^1wr crr^nczs ^se -inffiiiaC vat w^-^ 
iK^rij-rt r: tit jK3i i- *j. aari g ^eciicnrzsiii. ac Tt 
■w-jc-ji V- igTia: j'js -x jiriai i-im rie ^s&3L a 3e ^ 
CKUrsir; -y -iia-vei; ptriri.'s 'zkz. '- :s sucft jnrs iicij 
^-*.* " -: "I'j^ r«;.- ^r tjk ^rrr--::j* iesc jgi. tae '3r~ar: 

V- Vj- '-«_-■ .— c.r»n*r.': ir. -Izi: ^z.C- Tie -B-arrs ic aus- 
;;--,*r; int-.-A-.'jts V/ tit =itr: Tfair. sz ira-c ■•ociif r^ ar 
V- >fir.-*r.t tr.£> i^j'ifr..tj- 1:. c»*j-^— 2n r^3:s "B-ircErs. Tbt 
;-Vrrvv.: jVT. ',:' a. TJkZ zJH-i iiz ^KTrts^. :ie Trrr/c =: =e 

tfcrt 'J-jKT.:'^ ravi :>--— tjjt zs:i~.-z— salts jr^s =er£piQec a=C 
•rvi>; s^t i.'- i prrrir.tivt v, ■aizr^rt. Firr^r^itg.y. ■s^ec tie 
wof it <:.-*~^ to th« T^TEt zyarW iZ —-t csje s ir ^^^ »^K 
fj;/tTi.-.i%r. f'-r the rtnv.il of tb* -^,:ie 1=^ Mr. 5i=tsac 
Sn*;; '/ •i'rj^.i'A is of the ot:tr-:i- tiit the =^-e:^ry of 
c%t»rict in '^'.h-w-hAvtrs is overrttcc. 

It. hT. v-i'/'j'-. i.r.i'jit a-i p.5.;r.t;vi « tr_s.t t; .■;:"?. iirrstt 
iiro*r,:r.;: ;'. tr.': '.rv 'A ir.'z 'irZiztr G^-.rgi iziith. :: 
f ,',>..'•'...':, .^■''. 'i>.''i tr.': ::.: '. .;t;i;i tr.at exi-ttc ^r.:; Uie T-HZ,- 
hhi-.j': ir.at -n'-r'; ';r.'i-re^ 0/ ch:lirer. :r. ths bHckyiri; z: 
Kt.i'/.hTi'i or.ly a ft* yjari igo, "* The citter zi ;act that 
I 'ih'.,ij>i -Ai-.h to bulk out in ii'.'. its lar^er.eis a>i shame 
t>efor'; th"; r/r.ilar. tr.ro ;,y ir.c Chr:5t;&r.:ty cf Er.~'.5.r.c U thit 
in OJr bri'..<:*.'.->S. ar-'i brick works there are froci rc.ooc to 
yjf/Xj chii'lrer.p fro:n as io* as 3 ar.d 4 i:p to 16 and i~. 
uiA':iiC'jir.'i a ' rx.n'iage ' of toil ar.d a horror cf ev:'. trair.ir.g 
that oarri'-'i ;.';ril in it. ... I c^aim the protection of the 
la-.v for th'.;?:e children spc-zial'y, ar.d a'i children universally, 
by placing them within the inspection and regulation of an 
Act kindred with the Workshop or Factor>- Acts."' The 

' " The Cry of the Childrca from the Bnclc)-ards of Eagland," 1879. 



MISCELLANEOUS TRADES 



381 



ini 

m 



ipn of the children employed in the Midlands in bricit 
making in the seventies was dcplDrable. George 
Smith himself began life by assisting to make bricks at the 
age of seven, and he incidentally alludes to the harsh and 
unkind treatment often meted out to him. At the age of 
nine his occupation consisted In carrying upon his head 
loads of clay weighing 40 lbs. in weight from the clay heap 
to the table upon which the bricks were made. This went 
on, practioilly speaking, without intermission for thirteen 
hours a day. On one occasion after a customary day's 
work he was obliged to carry 1,200 nine-inch bricks from 
the maker to the floors upon which they were to harden. 
For all this labour he received sixpence. The fatigue 
induced brought on a miHous illness. SmiUi'a experience 
;Was only that of hundreds of other children. Boy» and 
iris from nine to twelve years of age worked together in 
the brickyards in a state bordering upon nudity. Their 
employment consisted in carrying damp clay upon their 
bead to the brick makers, or in carr>'lng away the made 
bricks to tlie drying floors ; and as the work went on for 
thirteen hours a day the children often travelled a distance 
of 30 miles, and yet the Government officials could not 
interfere, since the Acts of 1867 did not apply to establish- 
ments in which less than Rfty persons were employed. It 
was impo:i<itble for such young children, many of them im- 
properly fed and all of them poorly clad, to keep tip 
with the requirements of the men at work, and so between 
curses and blows this iniquitous slavery went on for years. 
As a proof of the heav>' weights carried by the children, 
Smith removed a piece of clay which a child of nine years 
of age was carrying and found that it weighed 43 lb;;. This 
child covered daily a distance of 12^ miles, in one-half of 
which the weight had to be borne In those days a work- 
man made on an average 3,000 bricks a day, equal to 
12 tons in weight, and these had to be carried by two 
children. Under these degrading conditions there is small 
wonder at the ignorance and immorality that prevailed and 
at the physical degeneration of the children. As the boys 
grew to manhood they rose to higher positions in the brick- 



382 



DISEASES OF OCCUPATION 




yard, but without any true knowledge of tbeir dottcs, 
retigious or social. Thriftless and ignorant, the yean went 
by, and when these men became pmnaturety old the 
workhouse was their goal. Eighty per ccnL of the males 
who applied to one of the large unioas for relief were 
brick makers. 

A Brickyard Act was passed in 1871 which Hid much 
to change the character, habits, and customs of those in the 
trade. Since then the children have been spared the long 
hours, and all of them can receive the benefits of a sdod 
education. They are no longer permitted to cofnmenoe 
work in the summer months at 5 a.m. and go on until 
8 and 9 p.m. Notwithstanding all that has been done in 
the way of factory legislation, cases still are brought into 
court of young persons being worked overtime and of beii^ 
obliged to carry wc^hts upon their heads far beyond their 
stroigth. 

Brick making cannot be said to be an unhealthy occo- 
pation, except as regards exposure to the weather, the 
temperature, and fatigue. The bulk of the work is carried 
on in the open air. Ulcers and varicose veins in the legs 
arc frequently found in the workers who knead the clay. 
The moulders suffer from painful and inflammatory swellings 
of the hands and wrists, and the palm of the faand3 may 
be the scat of a dermatitis.* 

As a consequence of the hard work men become 
prematurely old. In the brickyards around Cologne the 
workpeople BufTer from anxmia, due to the presence of a 
parasite in their intestinal canal (see "Ankylostomiasis"). 
[n England brick makers live at home, but in certain parts 

' The introduction of machinery is :iltering the nuonfactnr* of brkks. 
While thac pages ttru passin j; through tlic ptcm 1 have a young woman 
twenty years of age in my wjid, in Die lioyii Vtcloria Infirmary, who 
b a brickuaksr, and who, alUioagh a idroog, healthy girl and (rc« fiom 
organic diMaae, was admitted od aocaunt of sheer exhaustion. She 
wassimply wotn out. She informs mo that she can make 30,000 bricks 1 
ia one day, and that »he h paid at (be rale of twopcnoe-halfpcnoy 
per 1,000 bricks. The lifting OH of the bricks b driog work. By 
working from ft a.m. to 7 p.m. she has somettiiMS made at mtxh 
(rom 4>. to 4S. Od. a day. 



i 



MISCELLANEOUS TRADES 



383 



of the Continent the workpeople arc housed in wooden 
barracks, most of the dormitories of which have no windows, 
the bedding swarms with vermin, and overcrowding prevails. 
Rather than occupy such places the Factory Inspector of 
Augsbeig states that the workpeople sleep out of doors. 



Coal-tar, PiuA, and Allied Products 

Technical chemistry has demonstrated what a world of 
wealth and variety of colours arc concealed in tar. In the 
distillation of tar certain oily liquids are obtained. From 
the lighter oils benzine is obtained and from the heavier 
daraffin. Carbolic acid is also a tar product. During the 
di.stillatioii of tar, such gases and products as ammonia, 
carbonic acid, sulphuric acid, sulphurousactd, andcreasoteare 
giiixn ofil Persons brought into contact with these products 
occasionally suffer from inflammation of the eyes, running 
at the nose, bronchial catarrh, dyspepsia, headache and 
vcrtiga Frequently the skin becomes dirty looking and 
cyanoscd. Men employed in pitch works su^cr in a simitar 
way from the vapours given off during the pouring and 
settling of the molten material. During the pounding 
or grinding of dry pitch large quantities of dust are given 
off. Many of the men who follow the employment not only 
become bronzed and sallow, but their skin becomes the 
seat of a peculiar cancroid eruption such as is occasionally 
met with on the scrotum of chimney-sweeps. In otJier 
persons there may be bronchitis, digestive disorders with 
daric stools, also ulceration of the nose. 

The question as to whether manipulation of tar products 
or exposure to the fumes given off by coal-oil and tar is 
capable of giving rise to cancer has come before me in the 
case of three men employed in grease works. These men 
in following their employment all worked with their sleeves 
rolled up to above the elbow. It has been observed in the 
trade that when men have warts on their hands these 
frequently disappear when they first undertake the work, 
and, on the other hand, that in men whose skin has been 
quite healthy, wart-like growths are apt to develop when 




384 



DISEASES OF OCCUPATION 



they have Tollowed their entpIoyiDcnt for some time, 
addition to the waits, of which there may be a.s many as from 
thirty to forty on the hands and forearms, there develop 
hard nodules in the skin which ulcerate and often exhibit 
very little tendency to heal. The edges become hard, and 
the ulceration, extending to the deeper tissue^ may uiti- 
mately involve the bone and necessitate, as in one of the 
men I have alluded to, amputation of the arm. The appear- 
ances presented by the ulcer are those of the type of cancer 
known a.-! epithelioma. The presence of these warty Rrowths 
on the forearms and hands, and of ulcers that tend to take on 
malignant characters, in tar and pitch worlcers is so frequent 
that they must be in some way or other associated with the 
employment The morbid processes advance very slowly, 
and therefore do not readily unfit the individual for work. 
In many instances removal of the ulcer is not followed by 
any recurrence of the growth, but a return to the work lays 
the person open to fresh developments. On the forearms of 
one of the grease workers above-mentioned there are nnmcroiis 
small patches of induration, some of which have ulcerated 
and exhibit no tendency to heal. The edges of the ulcers 
are hard and brawny. There are, in addition, scattered all 
over the forearm numerous black warts of various .<itzes, 
also several scars of a pale colour compared with the 
bronzed skin that surrounds them. One of these men, 
aged fifty-eight, has worked among coal-oil and tar pro- 
ducts for thirty years. The scars referred to arc the remains 
of ulcers that have healed. In the case of his son, aged 
twenty-seven years, the ulceration took on the characters 
of malignant disease, and on that account the arm had 
to be amputated above the elbow. Although it is usual 
when the disease is treated by surgical operation for no 
recurrence of the growth to take place, in this particti 
instance the glands in the armpit and neck became sub: 
qucntly enlarged owing to infective particlc-s having rcac 
these glands by the lymphatics, and the patient became the 
subject of secondary cancer. Microscopical examination of 
the ulcer leaves no doubt as to the cancerous nature of the 
lesion. Knowing that in the case of chimney-sweeps' cancer 





MISCELLANEOUS TRADES 



385 



ic is present in soot, and may possibly be a cause of 
epithelioma, I analysed the coal-oil these men had been 
manipulating, but failed to find any traces of the metal. The 
Departmental Committee on Compensation for Industrial 
Diseases has recommended that the matadj' should be made 
the subject of compensation. 

^B Motor-car Driving: Motor Garage 

^B In the Lanc€t, July 7, 1906, Mr. W. J. Burroughs reports Uie 
case of injurj' to the spine of a motor-bus driver who, on a 
particular day, had considerable difficulty in starting his engine. 
In turning the starting-handle and giving it a jerk consider- 
able force was required. Owing to the muscular strain 
involved in this act he lost the power in his legs, and was 
for a time incapacitated for work. Motor-car drivers are 
exposed to all sorts of accidents, some of which are due to 
starting the cars, others to excessive speed, collisions. &c. 
I have recently had under my care a young chaufTeur who, 
when trj'ing to set his engine in motion, had one of his 
hands forcibly driven against the dial marker by the wheel 
revolving suddenly. His median nen-e was ruptured, and 
in consequence of a bad union having taken place there 
was loss of sensation and loss of power in the hand, which 
were restored by surgical operation. In what is known as 
"chauffeurs' fracture" it is the radius that is broken. The 
injury is consecjitent upon the sudden backward jerk of the 
starting handle. Pain in the wrist is at once experienced, 
and crepitation can shortly afterwards be felt. In some of the 
cases there is no deformity — the physical signs arc simply those 
I of separation ofthe styloid process — but inothers the deformity 
is considerable. The right hand, the one usually aJTctted, 
Is displaced in a dorsal and ulnar direction. The lower end 
of the radius may be found projecting immediately under 
the skin on the flexor surface of the wrist. Lucas-Cham- 
pionni^rc distinguishes two forms of chaulTcurs' fracture: "one 
direct, and caused by the tower end of the forearm being 
struck by the reversed handle ; the other indirect, and caused 
,i)y a violent jerk while the wrist is hyper -ex tended {fracture 
' arrachement). . . , Occasionally the fracture seems to be 




386 



DISEASES OF CX:CUPATION 



caused by the palm of the hand being violently strucit {com- 
pnssion fraetare)." • Madelung attributes the fracture to the 
fact that the hand is so forcibly bent backwards by the 
handle that the styloid process of the radius is torn oft The 
kind of fracture tliat ensues depends upon whether Che 
chauffeur retains liis grip on the liandle or not 

Chauffeurs have consulted mc for headache, loss of appetite,' 
and giddiness on account of inhalation of the petrol vapour 
when cleaning the cars ; others, in con&equencc of the 
strain upon their nervous system in frequently repeated long 
drives, have sought my advice owing to tremors and loss of 
confidence in themselves without any such concurrent cause 
as indiscretion in the use of alcoholic stimulants. Rest from 
driving for a few days, along with tonic medicines to which 
bromide of ammonia or potassium is added, gives <;atisfactory 
results and a speedy cure. 

It is unnecessary to emphasise the necessity for wearing 
goggles, on account of insects in the air and the irritation 
to the eye» caused by dust 

Persons driving in a motor-car have been accidentall 
pcHsoned by carbon monoxide gas. In an ordinary way 
carbon monoxide which is produced in the explosions escape* 
by a tube which discharges behind the car, and cannot there- 
fore injure the occupants. A Udy and her two daughter-i 
who had been driving in a closed motor-car became at the 
end of half an hour the subjects of tingling noises in the ears, 
vomiting, and unconsciousness. The car had recently been 
mended, and owing to loosening of the partitions of the floor 
the burnt gases had found their way into the interior of the 
car and had poisoned the inmates. 



M 



.ion 




The hardships experienced by laundresses who work 
home, and who in a large city like London have to com 
with the laundries owned by companies and run by machinery, 
arc graphically told by Miss L. A. E. Dcant, H.M. Inspector 
of Factories in " Dangercms Trades," to whom I am indebted 
for much that follows in the text. The social changes of our 
■ iJtdical kmcw, November, 1906, p. 5QI. 




MISCELLANEOUS TRADES 



387 






times, the {ncreaj^e of town populations, and a diminishing 

t aptitude on the part of the rising generation for laundry 
rk, are tending to the development of company laundries 
and public waahhouses, and so far as towns are concerned 
there is not the least doubt that these laundries will increase. 
To have the wa,shing done away from home is in some 
instances a ncccs&ity, in others it is a luxury. A new 
indu-stry has thus sprung up in our midst As time goes on 
it will give employment to an increasing number of hands 
drilled and organised so as to look after particular kinds of 
work. At present 100.000 persons are employed in laundries. 
In towns where the atmosphere is smoky bleaching can only 
be carried on by artificial means. Some of the bleaching 
powders used are injurious to the hands of the workers. 
They are a frequent cause of painful cracking of the skin 
and of eczema. Owing to the variety of the machinery in 
use accidents are not unknown. In certain processes the 
women are exposed to high temperatures, especially in the 
ironing department of large laundries where the washed tinen 
is drawn under hot revolving rollers, and where a tcmpciaturc 
of 90" F. even in winter has to be borne by the girls that feed 
the machinery. It is tlie use of machinery that has brought 
laundries within the sphere of the Factory Acts and enabled 
owners to employ comparatively unskilled labour such as can 
be obtained from girls of fourteen and sixteen years of age. 
As the public requirements increase there will be a greater 
demand for girls as machine tenders, for laundries run by 
machinery are fast displacing the hand laundries in which 
five or Aix women only arc employed and the work in which 
is frequently carried on in, or close to, dwelling-houses. It is 
unnecessary to descant upon the inconvenience and discom- 
forts of the washing day at home tn small houses, or upon 
the unhealthy atmosphere created by the steam and heat 
and by the disagreeable odours that are raised in the processes. 
The number of accidents in laundries is unusually large. 
I'll) 1906 there were 301 accidents reported to the Chief 
Inspector of Factories — 46 males and 255 females. The 
increased number of accidents affecting women and girls is 
probably the result of the growing use of ironing machinery 




MISCELLANEOUS TRADES 



389 



cmplo)^ in textile factories ; 76 hours a week may be spent 

»in laundries, not including meal hours. 
In visiting lai^e laundries I have been struck by the pale 
and anxmic look of many of the women employed in the 

I department where ironing by hand is carried on. Many of 
the women suffer from headache and tender eyes consequent 
upon bending over the tabic and inhaling some of the coal- 
gas which escapes from the tube or jets and which is kept 
lit to maintain the temperature of the irons. Some of the 
Ksymptoms arc the result of high temperature and mild carbon 
^monoxide poisoning. 

There is a current opinion that women employed in 
ftjatmdrics arc intemperate, and that the conditions of the 
work are such as to lead them to drink. The close atmo- 
sphere, the wet floors, and the disagreeable odours in some 
of the departments arc extremely trying ; the hours are long 

»iind the work is exhausting ; the chemicals used, such as soda 
and ammonia, by causing dryness of the throat create a thirst 
which the workers feel a draught of beer will allay. I was 
certainly astonished In visiting laundries in l-ondon to find 
that at certain hours of the day a stop was called and that 

^■cans of beer were brought into the laundry and sold to the 
workers. Is ihcrc any other industry in which twice a day 
the work of the factory ceases for ten minutes to allow of 

Bibcer being drunk by the workers ? When wc remember that 
it is to women the beer is being distributed and that the 
female sex is more prone than the male to some of the more 
serious nervous affections caused by alcohol, r^., peripheral 
neuritis followed by paralysis, to say nothing of the particular 
relations of woman to olTspring, no words can be used suffi- 
ciently strong to condemn a practice which, while it may 

^«llay immediate sensations, is in the long run productive of 

Bt^^ "*'^^' serious consequences not confined to the workers 
themselves. In many of the large ironworks in the North of 
England and in many of the factories wherein high tempera- 
tures arc experienced the men drink water in which oatmeal 
has been soaked. There is no reason why some such diluent 
as this or something equally simple should not be tried by 
women employed in laundries. 




390 



DISEASES OF OCCUPATION 



There is another side of laundry h'fe to which attention* 
must be drawn. Laundry workers exhibit a greater liability 
to pulmonary consumption than women following other 
employments. In the Clapham Infirmary of the Wandsworth 
Union while i of every 1 1 laundresses was found to be 
suffering from pulmonary' phthisis, among' female patients 
who were not laundresses the proportion was I in 19; in the 
I«Jcworth Infirmary the numbers were I in 10 and i in 20 
respectively. If anything were required to demonstrate the 
unhealthincss of laundry work and the liability tu tuberculous 
dtseasc created by it, reference need only be made to the 
writings of a French physician. Professor Ijindoury, of 
the Hdfwtal Lacnnec, Paris, has in La Presst M/duaie, 
October 6, 1905. described what is the experience of his 
own hospital in regard to this subject In Parisian laundries 
both men and women arc employed in washing and ironii^. 
The laundresses seek hospital treatment on account of vari- 
cose veins, ulcers on the legs, and for such pelvic troubles as 
uterine displacements, while the men apply for relief mostly 
on account of hernia. Injuries and bums arc frequently met 
with. What struck Professor Landouzy in laundry workers 
as compared with the other patients in the hospital was the 
high death-rate from tuberculosis as affecting mainly the 
respiratory organs. Tuberculosis was present in fully one- 
third of the 1.200 laundrcises and female ironcrs, and in less 
than one-half of the male laundrj- workers. The women 
were affected at an earlier age than the men. The men 
seldom suFTcrcd before the ages of 40 and 45 ; tlic women 
usually at 30. In both sexes the mortality was extremely 
high. Out of 23S laundry workers, male and female, who 
died in fi\'e years in the Laennec hospital, 143 died from 
phthisis. More males died than females. The mortality of 
male laundry workers from pulmonary consumption was js 
per cent, while it was 56 per cent, among the laundresses. 
This is an interesting fact, seeing tliat the women are afTectc 
at an earlier ;^e than the men. 

To what is this high death-rate of laundry workc 
from tuberculosis to be attributed? We must regard 
contributing causes the hard nature of the work, rcpcati 




MISCELLANEOUS TRADES 



391 



mncics, bad hygienic condition of the laundries, poor 
ling, and the intemperate use of wine and stimulants, but 
the main cause is undoubtedly infection, to which the workers 
succumb often after eight or ten years of service. The strange 
point, too, is that it is in many instances the healthy-looking 
and the strong men who become affected ; those who have 
gone about with the vans collecting the material to be 
washed, and who have therefore been much in the open air 
and lifting heavy packages, while of the women many 
have been robust and energetic. Such facta rather suggest 
_that in many of the patients there had been no spedal 
f predisposition to the disease, and that the contagion was 
caught by handling and sorting handkerchiefs which gave 
off, in a finely divided form, dunt from dried expectoration 
laden with tubercle bacilli, also dust from the clothes 
and soiled ttncn of persons suftcring from tuberculous 
phthisis, [t is by the inhalation of such dried bacilliferous 
dust that the high mortality of laundry workers from 
tuberculous phthisis is to be explained. Much of this could 
be avoided by patients using spittoons for collecting the 
expectoration. No doubt in the terminal stages of pulmonary 
consumption the patient is so weak that he cannot ex- 
pectorate into a dish, and he is tlicrcforc obliged to use 
something to wipe and dry his lips. Pieces of old linen that 
can be burned immediately after being used for this punwse 
are not only more cleanly, but arc bettor and freer from risk 
than handkerchiefs. In addition to the danger from tubercle, 
laundry workers are exposed to the risk of catching other 
infectious diseases. Many of U3 have known instances of 
women dying of smalt-pox, contracted by washing the 

» clothes of relatives who had been suffering from this disease. 
A few words in regard to laundries of large Infirmaries, or 
in reference to laundries to which the soiled linen of large 
Infirmaries is sent It h.is frequently happened that the 
sorters suffer from blood-poisoning. All infected clothing 
should be at once placed in a tank containing water and 
some such antiseptic as cyllin. Cyllin is twenty times 
stronger as a disinfectant than carbolic acid and it does not 
rot the linen like formalin, whose antiseptic powers arc only 




392 



DISEASES OF OCCUPATION 



O'jo of carbolic acid Cylliii has antiieplic propertie 
to pcrcKloridc of mercury. In the " calendering " department 
of a laundry, i.e.. where the clothes are passed underneath 
lari^e rollers, there is a considerable amount of steam and 
the work is extremely hot Phthisis is said to be occasionally 
met with in the girts who follow this particular work. There 
is a tendency in many modern laundries to substitute for the 
old drying horse large drying chambers. The objection to 
the drying chambers U diat the women have to go into 
chambers, and when there are exposed to extremely hi^) 
temperatures. In few occupations arc the ^wd eficcts 
free ventilation better seen than in laundries;. 

Within recent years laundries have considerably improved' 
In May, 1907, 1 visited Messrs. Char\efs laundries in Paris. 
These are quite up-to-date, and are worked by electricity. 
The soiled clothes, especially shirts that contain starch, are 
placed in a revolving drum in which there is water containing 
a diastatic fennent which has the power of transforming 
starch into soluble sugar. It is maintained that by removing 
the starch the linen is made much whiter. The clothes 
subsequently washed in soap and water, and afterwards in 
soluliun of ammonia to remove the soap. The ironing 
the larger and flat clothes is done by passing them under a 
revolving metal roller in the interior of which are gas jets 
kept burning, with an adequate amount of ordinary air. So 
complete is the combustion that, although it was towards the 
close of the working day that my visit was made, there v%a 
not the slightest odour of gas detected. To this circumstance 
and the good ventilation of the rooms I attributed the 
healthy look of the women in this room, as also the fact tha 
for ironing the front of the shirts only the old-fashioned 
hand-iron is employed, and not the hollow hand-iron with 
gas jet internally. Even in such a well-conducted laundry 
the sorting-room is the place where tliere is risk to health 
through handling the soiled clothes from tuberculous persons. 
Primary disinfection of the clotlies by meani of formalin 
and steam has been tried, but the formalin was fourxd 10 
destroy the linen, and as h consequence the method 
abandoned. 



ir aV 



» 



CHAPTER XV 



ElblERS, SAILORS, AMD FISIIGRMBN 



ALTHOUGH picked men and living when on home 
service under favourable hygienic surroundings, soldiers 
have a rate of mortality diftereiit but little from that of 
dvUtans of their own age. There are few middle-aged men 
in the rank and flic of the British Army, and while this is 
largely the result of the system that at present prevails, it Is 
admitted that a soldier forty years of age is in most instances 
an older man than a civilian of the same age. There is 
an opinion that the abolition of the "sentry go" as carried 
out by soldiers in former years and the assumption of this 
duty by a s[>ecial class of men known as military police will 
do much to lighten the burden of the young soldier and 
relieve him of work which was ntonotonous to and always 
disliked by him. Once a recruit has overcome ihe difficullies 
and liardshifvs of his training, he has often, if in the infantry, 
more time on his hands than he can usefully employ. 
He has therefore of^cn periods of enforced idleness which do 
not always help him physically or morally. His opportunities 
of smoking and of drinking are too many, and in other ways 
he is apt to go astray from paths that make for health. 
What is said of a soldier on home service applies with 
greater force to the soldier sent abroad. Foreign stations 
arc not all equally healthy. The fault is not always in the 
barracks, but in the country itself and In the carelessness 
of the men in regard to drinking water outside the barrack 
area. Again enforced idleness, ennui, Venus, and Bacchus 
tell their tale, and as a consequence the death- and sick-rate 
of the British Arm/ on foreign service is much higher than a 



394 



DISEASES OF OCCUPATION 



1 Ihe^ 



sunple rc\-icw of the circumstances would at first lead as to 
expect 

There will always be dangers to health Inddeota] to 
herding tc^cthcr large numbers of men in barrack-rooms i 
but the attention that is given by military authorities to the 
subject of overcrowding and tlie fact that in almost all 
barracks each soldier is allowed 600 cubic feet of space have 
done much to diminish the mortality from pulmonary phthisis 
in the British Army. During the first years of the late Queen's 
retgn the dcalh-rate from lung diseases in the Army per 1.00C) 
of strength was 7*82 ; In 1S9S there were only 2-5 cases per 
1,000 admitted into the hospital for pulmonary disease, and 
of these only a small proportion died. It is in barrack life 
that the good cRccts of \'cntiIation have been most marked. 

It is impossible in this chapter to deal at length with the 
diseases incidental to soldiering at home or abroad. Hn 
and other fevers claim annually large numt>ers of our soldt 
As many of our soldiers arc tost in the process ofmaki 
what I must do is to draw attention to the serious conse- 
quences that in many instances follow the hard training 
the young recruit has to undergo. Whether physical 
deterioration of the race is taking place or no we need not 
for the moment stop to inquire. All we know is that about 
half of the youths who present themselves for examination 
are refused on account of deficient height and xveighl, 
deficient chest measurement, and defective teeth. Of those 
who arc accepted a certain percentage go wrong in the 
training. The difference effected in the raw recruit by the 
exercises, drill, di.scip)ine, regular and substantial me«U 
is quickly apparent. He becomes in a few months a smart 
soldier with little resemblance when in unifbrat to 
former self. It costs the country £150 for every sold 
before he can be placed in the field as efficient 

Considerable discussion has taken place as to whether 
the physical training of the recruit is not too hard and the 
system faulty. Many of the recruits are young men who 
arc out of work, whose homes are poor, and who for 
months or years previously have not been able to obtain 
always an adequate supply of food. The training therefon 



•^1 



SOLDIERS, SAILORS, AND FISHERMEN 395 



res; 



should be gradual and the eRects of "setting-up drill" 
carefully watched. The object sought to be attained in 
training is the improvement of the physique of the recruit, 
but if the following is one of the modes by which an attempt 
is made to attain this, opinions will be widely divci^ent as to 
its utility. Surgeon A. F. Davy, speaking of the recruit, 
says : " He is made to stand bolt upright, his head well 
back, and his chest, being dilated to the fu1le:st in<ipiration, is 
kept as much as possible so dilated, an attitude u^ful for 
no kind or description of work." It is now several years ago 
since Surgeon Myers drew attention to the interference 
of the movements of the chest by tight clothing and accoutre- 
ments. Any attempt to change the shape of the chest 
and .skeleton should be gradual. Davy says that the 
"setting up"or rather " breaking down " drill of the recruit 
starts at his first appearance on the parade-ground, with the 
" position of the soldier." In an interesting paper by Lieut.- 
Colonel H. M. Deane,« M.D.. R.A.M.C., the whole question 
of the maintenance of the erect position of the soldier and 
his drill is fully discussed and the various drawbacks to the 
present methods pointed out Attention is being directed, 
and not a day too soon, to the affection known as " soldier's 
irritable heart" For this malady the " chest advanced " 
posture exhibited by soldiers standing to "attention" with 
their chest walls fixed and the abdomen retracted so that 
respiration becomes extremely shallow, is to some extent 
responsible. Unless a man can take deep inspirations 

,nd thus send on the blood from the large veins through 
ic right side of the heart and lungs and by full expiration 
ist the heart in propelling the blood into the arteries, 
the circulation cannot be effectively carried on. One 
of the results of standing to "attention" with the chest 
fixed in the manner just described, whereby inspiration and 
expiration are both impeded, is a tendency for the blood 
to accumulate in the right side of the heart and venous 
system and for less blood to pass out of the Icf) ventricle. 
The pulse rate rises : it will rise from 80 to too per minute. 

n some instances after exercise in the gymnasium and when 
■ JoMmal e/PretmtrM UtdUine, Mny, 1906. 




396 



DISEASES OF OCCUPATION 



the position of" attention " is maintained the pulse has risen to 
tzoancIi32. VVitli the rapid pulse there is also epigastric 
pulsation, and in many of the men a diffused cardiac impuUe, 
with absence of apical definition. E>eane submits the 
exercise taken by young soldiers in the gymnasium to 
stringent criticism. He considers it to be altogether wrong. 
Muscular exercise tends to increase the pulse rate, but if 
carefully conducted there need not be signs of disordered 
action of the heart as a consequence. The foundation 
of the heart trouble of young soldiers is laid on the parade* 
ground, and is intensified by the exercises in the gymnasium 
not being conducted on physiological lines. "The mischief 
done to the recruit on the parade-ground can be stopped by 
abolishing the present position of attention ' and giving tihort, 
plain instructions as to how to stand erect — in reality with- 
out constraint" The gymnastic staif ought itself to be 
properly instructed in physical training. There must be 
something wrong with a method of physical training; which, 
as in the Itritiiih Army, is responsible for the in%'aliding of 
such a large number of othcr\visc strong and healthy young 
men through disease of the heart and circulatoiy systcco. 
Since much of this arises before the soldier is sent on foreiga 
service it is clearly traceable to conditions at home, and 
which experience has demonstrated to be the result of faulty 
physical training on the parade-ground and In the g>' 
nasium. That the disability can be prevented is shown 
the fact that when soldiersare freed from the harmful physf 
conditions in the Army they usually make a good recoverj-. 
Wc must plead for die physical training of the soldier being 
conducted on physiological lines. What is retguired of the 
soldier is not well developed muscle at the expense of his 
heart and lungs, but a healthy and well toned heart and good 
lungs. It is these which will help him on parade and in 
military marching will enable him to cover distance with 
Itltlc fatigue. 






Tkt Marine Servict 

The lot of the sailor is a hard one, and >''ct as a clas^ 
sailors arc jovial and happy roai. It is only within recent 



1 



SOLDIERS, SAILORS, AND FISHERMEN 397 



years that attention has been directed to the hygienic 
conditions that prevail on board ship. Too often even now 
the sleeping accommodation provided for seamen is not good. 
There is a danger, too, in damp weather of too many men 
congregating together in an overheated and badly ventilated 
forccastk and of further polluting the atmosphere by 
tobacco smoke. Much has been done by legislation to 
improve the sanitary .surroundings of sailors on board ship, 
but there is still much to be accomplished. The good effects 
of the sea air obtained on deck arc to a large extent 
counterbalance<l by the overcrowdirig that pre\-ails betow. 
According to the Merchant Shipping Act, 72 cubic feet 
is the minimum space allowed per head, and in this space 
the sailor has to sleep, cat, and li%'c when off duty. The 
ventilation of the sleeping cabins, like that of the forecastle, 
is bad, and owing to the construction of modern ships the iron 
and steel sweat from condensation of moisture, so that the 
bcd-clothcs in the bunks arc often wet and uncomfortable. 
Notwithstanding these inconveniences, there are no diseases 
that the sailor is liable to specially attributable to his 
occupation. Persons become accustomed to almost any- 
thing. The sailor becomes accustomed to his frequent 
shifts, the intermittent character of his work, and the broken 
sleep. The habits thus formed in the early part of a man's 
life remain with him in his later years, bng after he has 
retired from the sea. His hours of sleep are shorter than 
those of most people. As a reaction against the confine* 
ment on board ship, the quietude of a long voyage, and the 
absence of amusements except those provided by their fellow- 
seamen, sailors on arriving in port are apt to give way to 
indulgence in pleasures that often leave a stint, behind. 
Many of their illnesses are therefore traceable to their habits 
when in port Their work at times is hard, and during storms 
tbey are exposed to risks to life and to accidents of all ktn<ls. 
A good many of the sailors why come to the Royal Victoria 
Infirmary are the subjects of thoracic aneurism, the result 
of hard work, sudden strain, and syphilis, also of the violent 
knocks and bruise:^ to their chest received during gales. 
In the case of sailors who have been all the world over, and 




39& 



DISEASES OF OCCUPATION 



therefore been exposed tothcinBuenceof tropicaJ climates and 
to drinking contaminated water there is frequentiy a history 
of malaria!, blackwatcr, and yellow fever, of dysentery and 
cholera. As a consequence, thctr health for long afterwards 
is undermined. Many of these men develop peculiar forms of 
bloodlessness, some of which pass into progressive or perni- 
cious an.-i:mia with a fatal termination. As a result of malarial 
fever the spleen remains enlarged for years, and long after 
the primary attack has passed away and the seaman li>'e3 on 
land he has recurrences of ague fever. Improved methods 
of feeding have, practically .speaking, abolished scurvy, i^icli 
used to be the scourge of the sea. The common diseases 
of sailors, such as those of the respiratory organs and heart, 
including rheumatism and phthisis, are partly the result of 
their immediate environment and insanitary surroundings, 
also of exposure and getting wet The lot of the stoker on 
our large ships is particularly a hard one. The temperature 
in which the work is carried on is extremely high, so that 
when tlie ship is passing, for example, through the Red Sea 
and the temperature of the outside air is high and there is no 
aerial circuUtion, the men often sulTer from heat apoplexy. At 
other times stokers run the risk of being chilled. Working 
with little clothing u|>on them, they often come out of the hold 
in a state of extreme perspiration to get a breath of cooler 
air, but the practice is not free from danger. That much can 
still be done to improve the health of the ordinary sailor 
and diminish risk to life and limb through accident, is shown 
by the difference in men following the same vocation but 
under different conditions. In the merchant service tbc 
mortality rate from all causes for 189^-99 was 9*60 per 1,000, 
while for 1899 the corresponding rate in the Royal Navy 
was 4*91 per 1,000, or about one-half The mortality figures 
of 9'6o per 1,000 in the mercantile marine were made up as 
follows: 7'4 from injury and 3*3 from disease. The 4*91 
per 1,000 of the Royal Navy were compounded of 5*56 frooi 
disease and i'35 from injury. These figures speak for them- 
selves. Probably some lives would be saved in the 
mercantile marine service were medical and surgical aid 
more readily available. The oHiccra of steam and sailing 




SOLDIERS, SAILORS, AND FISHERMEN 399 

ships ought to have some practical knowledge of ambulance 
work. 

Of the vocation of the fisherman little need be said. Like 
that of the sailor, the occupation is one attended by great 
risk to life from sudden squalls, dangers to health from 
exposure to inclement weather, occasionally long hours and 
irregular meals. Fishermen are liable to many minor 
accidents, neglect of which is often followed by blood- 
poisoning. 



RESCUE WORK IN MINES 



401 



dry part of a mina Gas is the enemy of the coat-miner ; 
90, too, is du!)t When mention is made of " mine gas " or 
" gas" in a mine it is mctlianc. marsh gas, or what is popularly 
known as " fire-damp," that is meant. Although the gas does 
not support combustion, it is itself combustible and bums 
with a blue Hamc. It is a product of the decomposition 
of OT^;anic substances, especially of vegetable fibre, in 
the absence of air but in presence of water. The gaa is 
pent up in Che coal frequently under such high pressure 
that it issues from the pores of the coal with a crackling 
noise well known to the miner. Mixed with oxygen, 
methane forms an explosive mixture, to which the term 
"fire-damp" ought only to be applied, and not to methane 
itself. The other dangerous gases are carbon monoxide, 
generated in an explosion, and the less poltonous carbon 
dioxide. I n a colliery explosion miners may be killed either by 
the severe shock or by the (lame, as the extensive burning of 
the body shows, but the largest number fall victims to the 
carbon monoxide gas whicK accompanies the hot column 
of air that has t>een generated. When an explosion occurs 
there is at 6rst an enormous expansion of the air in ihe 
particular gallery of the mine, consequent upon the 
production of hot gases. This is followed by a rapid 
shrinking. The hot gases pass along the path of least 
resistance, and having undergone combustion their volume 
is less than previously. Alarsh gas when exploded is found 
to have undergone a diminution of two-thirds of its volume 
after condensation of the moisture produced. An explosion 
in a coal-mine is followed by an enormous rise of temperature, 
to 300^ F. and higher. Upon the bodies of the miners who 
have been killed in a colliery explosion the effects of two 
different causes are obscr^-cd. There are wounds that have 
evidently been produced from without inwards and arc due 
to the enormous pressure of the gases at the time of their 
combustion, and there are wounds produced from within 
outwards during the cooling of the gases. These latter 
wounds are only met with upon the bodies of men who had 
been working a short distance from the seat of the explosion 
in a gallery that was a cul-de-sac or where falls had occurred, 

DD 



40Z 



DISEASES OF OCCUPATION 



Thus are explained the ecchymoses and multiple inji 
or wounds from without inwards, and the shattering 
disruption of the body when the wounds have been produced 
by causes operating from within outwards. In the blood 
of minen killed in this manner there is no trace of carbon 
monoxide on spectroscopic examination. Many uf the miners 
are killed by the column of gas suddenly striking then 
with all the force of a projectile. It is this shock or sudden 
impact that kills, frequently tearing asunder the limbs fnMti 
the body and hurling them yards away. That men thus 
killed had died suddenly is proved by the absence of the 
spectrum of carbon monoxide in their blood. Where 
the corpses exhibit marks of burning it mtgbt. under certain 
circumstances, be desirable to know whether the bums 
occurred before or after death. Miners who perish in an 
explosion from an expansion of the flame arc not reallj' 
burned in the ordinary meaning of the word.; it is more 
a singeing than a burning. Brouardel, in speaking of such 
cases, says the burns are not all serious, but as the air 
contains a large quantity of coal dust which becomes 
encrusted upon the skin of the body, the corpses arc black 
and appear as if badly burned. Most of the burns on the 
body are the result of the hot air. In the Coum'tres mine ' 
there was little flame— any that there had been was of short 
duration ; for while the clothes of the miners were not burned 
the underlying skin of the body was singed. It was therefore 
difficult to make a distinction between the bodies of mtnen 
who had died from bums and dead bodies which had been 
subjected to the action of fire. The burnt corpses were those 
of men who had cither been burned by the hot gasea or had 
been killed by carbon monoxide before the arrival of the 
flame It is very improbable that any absorption of carbon 
monoxide gas occurred after death. In another part of this 
book I deal with this subject Here I need only say that in 
none of the bodies of dead animals exposed c\-en for a 
week to carbon monoxide gas did I find that absorption of 
the gas had taken place. 

* Anaales etfiygihi. pttbiique et de Uidocine Le^e, Novembre and 
DcGcniiirc, 1906, EtiKlc Medico- legale dc la CaUtstrophe de Counict W . 
Dr. Firmin Dervicux, I'aris. 



RESCUE WORK IN MINES 



403 



The largest numbers of deaths in the Courri^res mine 
were due to carbon monoxide poisoning:. Several of the 
bodies of the dead miners were found in the position in 
which the men had been working when death suddenly 
overtook them. The force of the explosion had driven 
before it a column of gas containing carbon monoxide, and 
as this gas became cooled on its course along the galleries 
it immediately poisoned the workers who inhaled it When 
death take<i place through inhalation of air containing a high 
percentage of carbon monoxide gas convulsions do not 
occur. The features are perfectly placid. It is in slowly 
induced intoxication by carbon monoxide that the locomotive 
powers become enfeebled. Of the occurrence of this there 
was evidence in some of the miners at Courritrcs ; for the 
men, feeling that there was something wrong with the air 
they were breathing and probably experiencing headache 
and vertigo, had tried to save themselves, but as the gas 
travelled more quickly than they were able to walk it over- 
took and poisoned them. 

I have taken as the basis of my remarks for this chapter 
the mine catastrophe at Courricrcs because it is the greatest 
mining disaster of recent years. It Is said that one of the 
most painful circumstances to the relatives of the deceased 
miners was the difficulty of rcct^nising the bodies owing to 
the injuries and putrefaction. In Ihe mine itself one of the 
most trying circumstances the rescue men had to deal with 
was the rapidity with which putrefaction of the dead bodies 
had occurred, the unpleasant and repellent odour that pre- 
vailed, and which made rescue work a peril to the health of all 
who attempted iL Some of tltc wounded miners who were 
brought to hanlt only lived a few days. Most of them died 
from pneumonia, either due to having respired the hot air 
in the mine — which is scarcely likely, for death would prob- 
ably have come more quickly — or as the sequel of carbon 
monoxide poisoning. Dr. Lourties states that several of the 
miners died from pneumonia 50 to 60 hours after being 
rescued. The inflammation of the lungs in each instance 
developed with great rapidity, and was accompanied by 
a high temperature. The pulmonary lesions, which were 




RESCUE WORK IN MINES 



405 



and colliery oAicials c:in brings to bear the unite<l Influence 
of the allied sciences. One of the greatest difficulties 
rescue parties have to encounter is the extremely high 
temperature in a mine after an explosion. ThLs, while a 
serious difHculty, ought not to be insurmountable. Science 
has already accoiiipli.shcd much in the saving of human life; 
it will yet do more. 

In 1846 Sir Henry T. dc la Beche and Dr. Lyon Playfair 
reported that after a colliery explosion there was, but for 
carbonic acid, a sufficient quantity of oxygen present In the 
mine to support life where men had survived the imme- 
diate effects of the explosion. Three years afterwards 
Dr. John Hutchinson proposed that an exploring party 
should carry bags containing air into the mine, 90 that 
they might exist for half an hour. In 1880 Henry Fleuss 
invented an apparatus which was used with some success 
at Seaham Colliery in the following year. Twelve months 
afterwards Uavid Rhys Jones showed that oxygen could 
1 be used for rescue work in mines. In the early experi- 
ments men were provided with a tube which they placed 
in their mouth, or it was 6xed to the helmet, and through 
this tube atmospheric air was pumped from without, 
as in the case of divers, but the disadvantages of such a 
method arc that the tube might become kinked, and owing 
to the distance the men might have to travel the tube 
would become extremely heavy. It is, therefore, necessary 
to have an autonotttotis respiratory apparatus which will 
enable a man to carry with him a sufficient quantity of air 
to render him independent of the atmosphere immediately 
urrounding him, and which at the same time slull cut him 
off from the possibility of inhaling dangerous gases. When 
compressed air was first tried it was found that men could 
support themselves in a poisonous atmosphere for twenty 
minutes. Since then many improvements have been made 
in the forms of respiratory apparatus. On the Continent, 
one of the pioneers of the movement is Dr. Guglielminctti, 
whose experience as an aeronaut and an Alpine climber 
enables him to speak with some authority as to the value 
of compressed oxygen, and whose invention has been adopted 



406 



DISEASES OF OCCUPATION 



by the Dracgerweric at Lubeck. Atmospheric air con 
in vohimcs 79x14 nitrogen, 2093 oxygen, and carbonic acid 
003, while expired air contains 79*6 volumes of nitrogen, 
16104. oxygen, and 4 of carbonic acid. About the same 
quantity of carbonic acid is given off as there is of oxygen 
absorbed. There is a mutual interchange between the two 
gases. A man requires not less than 500/100 cubic inches 
of air per 24. hours. In other words, he gives ofT per hour 
hair a cubic foot, or 864 cubic inches, of carbonic acid aixl 
the same quantity of oxygen in absorbed. Any person 
attempting to do rescue work should therefore be provided 
with not less than 1 cubic foot of oxygen per hour. Mr. 
W. K. Garforth,' Allofts Colliery, Normanton, who has gi\'eD 
considerable attention to the practical study of this question, 
says that " if a workman had given to him a cylinder con- 
taining 3 cubic feet of oxygen at atmospheric pressure for 
the outward journey, and a cylinder containing 3 cubic feet 
at atmospheric pressure for the return journey, he would 
under any circumstances, unless there was great waste, have 
sufficient oxygen to last for 2 hours, even if during Chat time 
he underwent considerable exertion." In the respiratory 
interchange of gases in the human body nitrogen plays no 
part. The gas is quite inert, and this is one of Uie rea»oni 
advanced for not using compressed atmospheric air tn rescue 
work, since, nitrogen being lighter than oxygen, would be the 
first gas to be given off; also, in order to carry a sufficient 
quantity of respirable gas, the weight of tlie apparatus would 
be considerably added to by the nitrogen, which, after all,! 
of no special use, since it plays a purely passive part 
respiration. By eliminating nitrogen the apparatus can be 
reduced to one-seventh of its original weight. In a demon- 
stration given at the Institution of Mining Engineers, 
Newcastle-upon-Tyne, Mr. Otto Simonis' showed how the 
" aerolith," a liquid-air rescue apparatus, could be employed 
ia mines aJcer an explosion. The entire apparatus weighs 

* " A New Apparatus (or Rescue Work in Mlaos," TraniocUtm t^Ou 
tmSiiuhon (4 Mining Eiipnetn, Juno 14, tgo6>. 

■ TraHtadiont Mining Engincen, 19061 "Liqnid Air and its Ulc in 
Rctcuc Apparatus." 



il 



RESCUE WORK IN MINES 



407 



[4. lbs., " is easily carried oi] the back without any encum- 
brance, and it gives an absolutely pure and dcliciously cool 
air^supply for up to three hours' working. It docs not 
contain any chemicals ; it is without any complications 
whatsoever ; there is not a single valve in the whole 
apparatus, and its use docs not require any special training. 
Atmospheric air liquefies at a temperature of — 191* C. and is 
compressed to about the seven-hundredth to eight-hundrcdtK 
part of its original volume; Consequently I gallon of liquid 
air will evaporate into 700 to 800 gallons (1 10 to 130 cubic 
feet) of atmospheric air." When fully charged the entire 
apparatus weighs 24 lbs. Liquid air contains 2 parts of 
oxygen to 1 part of nitrogen. Simonis claims for his 
apparatus, that the ffesh air^supply is always ample, that it 
is absolutely pure, and that it can be stored in the vacuum 
vessels designed by Sir James Dewar, but losing from 5 to 10 
per cent by evaporation per day. Liquid air can be pro- 
duced at the rate of threepence per gallon and upwards, 
according to the size of ttie plant 

In respiration only 4 per cent, of the oxygen inhaled is 
taken up by the btood passing through the lungs; the 
remainder is exhaled witliout being utilised. To replace this 
loss of oxygen there is added to tKc exhaled air 4 per cent. 
of carbon dioxide. With physical exertion the amount of 
COa is increased. It is this gas which, when it accumulates 
in too large a quantity, becomes a source of trouble, and has 
therefore to be removed. When present beyond I per cent, 
it causes headache and a sense of distress. In all forms of 
rescue apparatus, therefore, provision is made for the absorp* 
tion of the carbon dioxide by passing it through a scries of 
tubes contiining a solution of caustic potass. The air thus 
purified passes further on through the apparatus, where at a 
particular part it meets and mixes with the oxygen coming 
from one of the cylinders. In all forms of rescue apparatus 
the oxygen should escape from the cylinder automatically 
into a tube going to the mouth-part of the helmet worn by 
the miner. The air that has been breathed becomes hotter : 
at the increased temperature it becomes a source of incon- 
venience and uneasiness to the wearer of the apparatus. 





RESCUE WORK IN MINES 




(l23 cuImc inches) of oxygen per minute. Too much oxygen 
must not be supplied, as it causes dryness of the throat. 
Nearly all the forms of rascuc apparatus arc designed on the 
sainc plan. 1 1 is desirable that the apparatus should be capable 
of being put on and taken off by the wearers themselves, also 
that men should be practically trained a-s to its use, so as to 
overcome the nervousness which is invariably observed in 
those wearing the apparatus for the first time. Minemana^rs 
and mining officials are of the opinion that there is as yet no 
ideal rescue apparatus in the market, but the vast strides that 
have been made in this direction within recent years show 
that many difficulties have already been surmounted, that 
there is every prospect of a more perfect apparatus being 
reached, and to accomplish this British inventors are doing 
their part. A feu* years ago it was proposed by the Midland 
Institute of Mining, Civil, and Mechanical Kngineers to 
establish rescue stations, at which men might be trained 
in the use of life-saving apparatus in colliery explosions. 
In 1S99 Mr. W. E. Garforth. of Altofts Colliery. Normanlon, 
arranged for the construcb'on of an artificial gallery in which 
experiments might be carried on. I have had, through the 
kindness and courtesy of Mr. Garforlh, the opportunity of 
witnessing some of these experiments. At Messrs. Pope, 
Pearson & Co.'s colliciics four men have been undergoing 
training in the gallery. The gallery is 150 feet long and 
forms three sides of a square; it is 6} to 7 feet high and 
is air-tight. It is provided with windows, through which 
the experiments can be watched. A successful effort has 
been made to make the interior of the gallery resemble as 
far as possible the galleries of a coal-mine that have boon 
wrecked after an exfJosion, where the floors are covered 
with debris, timber has been broken and blown out of its 
place, the roof fallen in here and there, so as to make 
walking impossible. Into this gallery, which is filled with 
smoke and noxious fumes from burning sulphur, timber, 
leather. &c., the men. wearing an apparatus of Mr. Garforth's 
own device, enter. Each man is provided with a double 
cylinder of oxj^cn and an electric lamp. The men work in 
couples, and Ihey have lo encounter the physical difficulties 



410 



DISEASES OF OCCUPATION 



that arc likely to be met with in a coal-mine after 
explosion, including the presence of poisonous gasea. 
have also to extinguish a lire and to bring out of the gaJlcfy 
a dummy, a supposed injured or dead miner, weighing 
i6o lbs. I saw these men, wearing the apparatus on thdr 
back, crawl on their knees over as rough surfaces as any 
likely to be met with in a wrecked mine, extinguish a Sre and 
bring out a dummy miner which they had themselves brov^lil 
through a broken iron pipe i8 inches in diameter, also pullod 
and pushed it over rough falls of stone. In the three hours 
during which the men were in the artificial gallery the)- 
walked and crawled a distance equivalen'.. to two and three- 
quarter miles ; they also performed all kinds of bard wt>rk.i 

111 the earlier experiments carried out by Mr. Garforth, Vn, 
T. Marshall Nicholson and A. Mackenzie, of Leeds, recorded 
the pulse rate and temperature of the men before entexii^ 
and again on coming out of tlic gallery. With the physcd 
work it was found that the rate of the pulse increased and 
there was a rise of the body temi)erature from i° to s° F. 
The men complained of headache, which in half an hour 
disappeared, also of nausea and giddiness, and it was observed 
that they were cyanosed in the face owing to the congestioa 
of the blood-vessels. Suice tliat date Mr. Garforth ha* 
considerably improved his apparatus, known in the trade as 
the " Weg,** and with it even after prolonged test* there an 
no longer complaints by the men of headache, nausea, of 
feeling of sickness. The men come out of the gallery after 
three hours' hard exercise fresh uud fit for other work. Tbc 
total weight of the " Wcg " apparatus ts 21 lbs. 5 ox. 

A series of experiments carried out by men wearing the 
Draeger apparatus has been equally successful The men 
emeiged from the gallery after having performed arduoi^^ 
work for two and a quarter hours without signs of fatigue. ^H 
was shown too that the men wearing the Draeger wcr^ 
capable of lifting a greater number of pounds weight in a 
given time than with some of the other forms of apparatus. 
For a full description of this apparatus and its power of 

■ TMnsiUliom of the Imhlutioa 0/ UtMiug Engiietn, vol 



RESCUE WORK IN MINES 



411 



I 



removing COa from the exhaled air see pamphlet " Tests of 
Life-saving Apparatus," by H. and B. Dracgcr, Lubcck.' 

The Director-General of the Society of Mines at Lens, 
France, informs me (August 7, 1907) that several experiments 
have just been made in the mines at Lens with the safety 
apparatus invented by Dr. Tissot, which he regards as 
superior to the other forms of apparatus that have hitherto 
been tried. Two coal-miners wearing the " Tissot " safety 
appliance were able without any previous training or 
experience of the apparatus to penetrate into the various 
parts of the mine for three hours, and when there to undergo 
work of such an extremely fatiguing nature as had been found 
to be impossible in experiments with other forms of apparatus. 
The apparatus is of the same type as the " Wcg." 

Through the kindness of Major Cardier I have had the 
op|>ortunity of seeing the firemen at one of the barracks of the 
ij a peurs- Pompiers, Paris, demonstrate the applicability of 
the rescue apparatus invented by one of their ofTicers, 
Lieutenant Vauginot One of the peculiar features of the 
apparatus is the warning given by a shrill whistle when 
the compressed air is almost played out Two cylinders of 
compressed air arc carried ; these t(^cthcr last forty minutes. 
The expired air escapes by a valve below tlie helmet. The 
apparatus weighs 32 lbs. The Vauginot appeared to me to 
be useful for Bremen going into a building fiDed with smoke 
or poisonous vapour for a short period. 

If rescue work in mines after explosions is to be carried 
out on sound practical lines and on scientific principles, tlierc 
ought to be training stations in diflercnt part:! of the country. 
The subject is one to which medical men engaged in colliery 
practice, also casualty surgeons to police authorities, should 
give attention. Training in re*icue work ought to form part 
of the ambulance instruction given in mining centres. If 
young men who are being educated for the higher appoint- 
ments in mining were also trained in rescue work, the 
instruction would be invaluable to them, since they will be 
the mine managers of the future. 

■ Oblainabl« from R. Jacobson, 1 1, Water Laiic, Great Tou-cr Street, 
Loadon, K.C. 




412 



DISEASES OF OCCUPATION 



To Efet to the entombed minera ii one of the diffit 
in rescue work, owing to the high temperature, and another' 
difficulty is the removal to a place of safety of m inert foand 
alive. By a rescue party an extra number of masks would 
hai-e to be carried, which could be placed on the face of the 
men who when found sho^v signs of life, oxygen supplied, and 
its entrance into the lungs secured by artificial respiratioa; 
in addition eflbrts would have to be made to bring the 
miners to the surface as soon as possible. Much yet remaiai 
to be done before rescue work by men wearing spccul 
respiratory apparatus can be regarded as perfectly safe. In 
Austria fatalities have occurred to men wearing^ these, bot 
only when the appliance has been of the type ir) which 
reliance is placed upon chemical decompositions being 
eflected and oxygen liberated, and not when the men have 
been carrying small cylinders of oxygen in the manner 
detailed above. 

Any doubts held by colliery manners as to the practica- 
bility of the use of rescue apparatus tn mines after explosions, 
if not removed by the Garforth and other experiments 
Alluded to in the text, ought to be by the results obtained 
under the following circumstances: — On Sept 14, 1907, an 
explosion occurred in the "Saar" and " MoscI " Colliery at 
Meribach in the Prussian Saar district A rescue party of 
twelve men, equipped with theDraeger apparatus, descended, 
and, after working for an hour, brought to the surface the 
eight survivors and the bodies of four men who bad been 
killed by the explosion. Vide Iron and Ccal Trades Review, 
ScpL 27. 1 907. 




INDEX 



Aoddents in cool mines, 375 ; in 
bnandrics, 387 

AcddciiU In Die iiuniifadnrc and 
use of L'xplo^vcs, 134-36 : in 
coal ininci, 375; in laundncs, 

Acniird, tiis cxpeTimcnts on ani- 

riinN with tobercJe tncilli. 17 
Aerated naleri, nunufactnre of, 

374 
Air-lock, described, 89; effect on 

eittcnng. )^. 90 ; condition of 

workers wt^ii leaving, qt 
Atoohol, dctrimentaj effect on 

workers, 2, lo, 34, lai ; pr«dis- 

poang cause of plumbism, 147, 

148, 106 
Aldrich, Dr. Charica, oetirolojlist 

to the Cluvclaod HospiUl, Ohio. 

363 
Almadcn, mercury miaes at, 234 
Alps, effects of climbing tbo, 115, 

116 
Altitude, its effect on the body, 

115-19 
AmtTici, »pced oif tnuchtncry in, 

3 ; industrial pressure, 5 
Amsterdam, tunnelling operations 

in, 105. to6; dlsmond cutting 

induatrv at, 170, 171 
Aa.-cmia, iTom excessive heat, 379 ; 

from ankylObtomiasis, 311, 310, 

3*5. 31* 
Ana.inia, rainers, 3' I, jaoi 335; 
I from ankylortonuasis, 326 
Anpi\ Mr. H. B,, 139 
Amlino pCHsoning, t3$-2i 
AiikyltntomiaHS, ccmMdered, 3 1 3- 

jj J symptonutologjr, 333 ; an- 



ieniia and, 326 ; ticatmcnl of 

398-13 

Antnrncoii;, 3^7 

Aiithi'ax, couxiaorcd, 334 ; symp- 
tomatology, 339 ; treatment of, 
342-45 

Antwerp, uinmond-cutting indus- 
try in, 170 

Arcn«, on du«t, 245 

Arlidgc, Dr„ on |)ott«nt' long 
discaws, 305, 308, 309 

j\rmit. H. W., ms opinion on poi- 
sonous effect of nickel carbonyl, 

74 

Arnaud, Dr., on the effect of Ihc 
fumes of phosphorus, 44 

Arsenic poisoning considered, 
316-18 

vViquilh, Mr., Commillcc ap- 
pointed by, to iiitiuitc into llie 
industry- of blankct-stoving, 86 

Assyrian pottery, 168 

Asthma, chcmi«SLl workers subject 
to, 110 

Atmospheric pressure, com- 
pressed, considered, 83-io8 ; 
diminiKlied. o-mMdcrod, 115—19 

Austialtj, minc« in, 195 ; parity of 
wool from, 338 

Austria, compcnsalion of workers 
in, 17 ; match-making indD<;Iry 
in, 39-41 ; reguUlions for lead 
factories in, 144 

B 

Babylon, enamelled bricks of, 168 
Baccarat, KlasJi works at, iHi 
Uakcr Street und Watciloo Rail- 
way tunnel works, 94, 97 



W 



INDEX 



k 



Broobl}-n Bridge, ooDdition of 

workers on th«, ^, 97 
Brouaxdcl, Professor, on tubcfca- 

losis, 13 
Brawn. Dr. Sanger, his report of 

n caxc o( coal-gas poUonin^ 71 
Brown-Scquard, his cirpcrinicnts 

apon aniuuls witli expired air, 

Brunei, caissons utcd by, 91 
Biy.ii)t and Uiiy's Match Works, 

hvaltli ol wotkun in, 51 
Buhr MoRC. workers in, 306 
Bi:rrfiiighK, Mr. \V. J., jS* 
BuTslcin, pottery worfc^ial. 158 
B}-»«>n, on the eBecU ol nULS- 

cuUr work, 9 
Bysiinosis, 247 



Caermsrlheii, tin-plate mills at, 

Cahcn, M., ose of tcsquisulphidc 
of pbosphorus for matcfaea dis- 
covered by, 40 

Caissons, described, 88 : effect on 
workers when cntciine the nlr- 
lock, 89 ; condition of work in, 
90 ; the lighting of, 90 ; condi- 
tion of workers on leaving 
th« air-lock, 91, 91 ; those used 
by the ClevelaDd Bridge Ca 
dcscrihcd.oi, 93 j "compressed- 
sir illnc^ ' from working in, 
9J-5 ; causes of illne» con- 
sidered. g6~to8 

Calcutta, jiitc induxtrr in, 355 

Caimcllc, oil pncumoKOniosis, a^$ 

Cancer, il* rewtion to injury, 2-1 ; 
death-rate from, in chimney- 
iwecp», 163 ; workers in coal- 
oil and tar subject to, 383 

Carbon monoxide, poisonous ef- 
fects of, 5S, 59 ; given off by 
bl^st fumiice*, (iS-di ; $];oip- 
lonii and pathology of poison- 
ing by, 63 ; pcnetrAiion of, into 
dead boaes considered, 64-^ ; 
acditnatitation of living bodies 
to,«6-8 

Carbonic acid gas, conaidenxl, 
54-».97 



Ctfdicr. Major. 411 

Onrpathian Mountains, petrol 

springs in the, 85 
Cartcll. on carbonic add p(ȣOii- 

ing.55 
Caspar), on mountain climbing, 1 16 
C^tiiraci, gkus-blowen Mtbjcct to, 

579 

Cerrocle Puca, capper>iRincs at, 
118 

Chaliciviis, X47 

Chamberlain, Mr.,Utncn* Phthisic 
Commif^on .ippoinlcd t>y. 779 

Charcot, hi^ opinion uii lead palsy, 
209 

Char vet's, Messrs., laundries in 
I'aris, 393 

Chasscvant. A., on the effect of 
carbon hisniphide on the btood, 
78 ; his cxpciiments upon ani- 
mals nilh bcniine, 84 

Chavi^nv, P., " Dtagnosttc dcs 
Maladies Simul^, by, 31 

Chemical trades, lUticss among 
workers of, 120-39 

Ctiiiuncy sweep's cancer, 362 

Chinese labourers in Smith Africa, 
dealh-iatc amonR, 289, 391, 39a 

Chloride of lime, nianuiattnre oi, 
120 

Chloride of sodium, skio eruption 
OLUsed by, [33 

Clay, Dr. John, 16 

Cicrcland Bridge Company, their 
work on the Tjac, 93, 93 

Coach-painters, health of, 187 

Co.it-gas, asphyxiatioi) by, 71 

Coal-mines, improwd ventibtion 
of, 367 ; phthisis among workers 
considered, 368-72 ; aibnenU of 
workers, 273, 374; explosions 
in. 400-403; rescae apparatus 
considered, 404-408 ; rescue 
training 409 

Coal-tar, health of workers in, 
383-84 

Compressed air in caiisions do* 
scribed, 88; proper supply ol. 
considered, 91-3; illne&s aris- 
ing from working in, 93-6 ; 
causes of illness from, con- 
sidered, 96-108 

Cope Bros., Messrs,, tobacco 
works of, 264 




4i6 



DISEASES OF OCCUPATION 



Copper, bannful dfocts of, oon- 

sidcrccl, 3U/-ao 
Canuag, Dr., on caisson disease. 

104 
Cornwall, lin-mining in, 300: 

ankylostomiasis in Uic miners 

o(. 314,330,323 

Cotton Cloth Fftcloriei Act, 951 

Cotton mills, health of workers in, 
considered, 148-53 

Coiirricrcs, explosion in coal-mine 
at, 4a>-403 

Courtois-Suffit, Dr., quoted on 
health of match worker k in 
France, 50 ; on condition of 
womun wxirkcnt in tobsicco 
factories, 366 

Cozxolino, M. O., 328 

Cromiuivl, Professor, ou the poi- 
sonous giiscs given off by fcrro- 
silicon.og 

Ciowii Uccf, dealh-ra(« of rock 
driUcTit ou the, 284 

CrzclUticr, IS., his report on " elec- 
trical ophthalmia. ' 354 

Cuoninghaci. Dr. Geo., memtKi 
of Pho^lioini& Cotnmitlcc, i(> 

Cutlery, mannfncturc of,duKxil>ctI, 
330 ; iiigti dc.itli-ratc from tubcr< 
cuius: amuug workers of, 231, 
3X3 : works at Solingcn and 
ShcKcld compared, 333, 934 

Cyanides, use of, in extraction of 
gQld, 335 



Dwnaraland, death ■ rale amonf^ 

iialivc miner* from, aSg 
Daii^vniiu Tiiidcs Committee, 77, 

iHl. 306, 350 
D'Arsoiival, nia experiments upon 

animals with cxpirMl air, 56 ; on 

dcciric currents 349> 3>[ 
Daodin, M. Pierre, attittidt; of, on 

Ihc use of white lead, 189 
Davis, Mr Fiaiik, 93 
Davy, Sir Humphry. 376 
Davy. Surgeon A. F., on physical 

training of soldiers, 395 
Dcanc. Ucut.-Co»o(»cl H. it., on 

lliu ptij-iical tnuDing of soliticrs. 

39S 



Dcaitc, Misa L. A. B^ 

of Factories. 3S6 
DMrdcn, Dr., quoted, 46 
Dommc,oa chcsl-wouitds followed 

by tabercuk>»&, 14 
Denayrouse, diving dress ioveoted 

by, 110 
Denbif(h&hire, ganiiitcr mioing in. 

Denmark, use ol white pbosphonis 

intcrdictfd in, 48 
De\var, Sir James. 407 
Diabetes, cau^scd hy accident, 15, 

Diamond catting described, 

•'■ . 
Di-nitro-bcniene poisoning, 

(29 

Disease smulalcd, 36 
Dixon. Professor, bis inreslij 

of Afticin Iraxwood, a^^ 
Diiwrwic vlate ijuarries, 30a 
Divers, dangerous occupation of, 

109 i disease owing to ocxiqa- 

tion, no, til : coitomcof, lii: 

in the Navy. 113-14 
Dohson, Mr., Inspector of Pac- 

lories, Sheffield, 192 
Dolcoath tin-minea, 314 
Dole, Colleee of Arc. at. 39 ; birth- 
place of nsteur, 40 
Domestic aervanls, bealih of, con- 

sidcrcd, 365 
Dracger, rescue apparalnsinvc 

by. 408. 410.411 
Dnr clc:uitii|! by meaos of 

aiscusscd, ita-5 

Dundet, julc industiy at, 355" 

Dnpre, Dr, on lead poiMining, 157 
Durham, fianisler minins in, nfi 
Dust, injurioiit efifccts ot, 3^»-^ : 

ns a picdisposioff cause ct 
miners' phthiiis. 379-85. J^ 
300, 301, 30S-307 
Dye works, nse of aniline in. : 
i:A ; use of lead in, lit: 



Earthenware, iee Pottery 
Keypt, ancient pottery of, i(^ 
ElKlric accumulator works, 
poisoning in, 175-78 



INDEX 



4J7 



Electric welding, dangerous to the 

^ "ye*. 353- 355 

Electricity, cktDgers of, ooosidci ed, 

347-49 ; cause of death by, con- 
sidered. 350-53 
Elgin, Karl of, ago 
Embdcn, on paiioning in num- 

ganete workers, 327 
Eincty>wl)ccis, 237, 338 
Emphjfscnui, pulmonaiy. in glas;^ 

blowers, 376, 377 
EiiMiictling of iron plates de> 

sciibed, 172-75 
Eocqjlialopalhy, " caused " by 

"Um poisomtic," 305, »". 9'S 
F.nginc'drivcrs, ncalth of, coa- 

sidrrcd, 358 
Epilepsy simuUted, 27 
Eurick. Df. P. W., of Bradlofd, 

Evans, WillmoU, ato 
Explosives, oonsidccd, 130-36 
Eyesight, loss of, in lead poison- 
ing, 204, 306, 907, and elec- 
tricity, 3^3, 354 : frequency of 
catand in gla.vvhlo«rcrs, 370, 
38J 



Padoriea, control of match, con- 

SKtcred, II ; ventiUlion of, 56 
Fatigue, imporUnt f.ictor contri- 
buting to industrial discasesand 
accidents, 1, 4 ; definition of, 6 : 
loxinH of, considered, 6-9 -. 
^- effects of, 9 ; intellectual and 
^H miucular, considered, q; pre- 
^B vcntion of, 11 
^vPenton, pottery works at, 158 
^H Petri carbanyl, 74 
^M Ferro-silicon, poiMtnous gas given 
■ ^ oS by. 60 

^■Festlnlog. health of quarrymen in 
^^ the_ mines of, 301-303 
F Fierte - loua - Jouarre, tniltstone 

building at, 306-307 
« Kile-cutting descril>ed, 168-70 
Fish-curing, considered, 367-70 
P\ax worktn, 253 
FIcuss, Henry, respiratory appar- 
I' atW' invented by. 40|t 

Forgemen. health of. IM 
FortA [fridge, the building of, 
94 




Fournicf , of CKjoo, 334 

France, compeniation of workers, 
in, 30 ; health of match workers 
in, 47, 40 ; u»e of wsquisutphklc 
for making matches in, 4J9-51; 
legitlaliun on the a*e of wlute 
lead, 188-90: condition of 
workers in State tobacco fac- 
tof ie^ 363-66 ; slalulici of acci- 
dents in coal-intnc», 175 ; slate- 
mines in, 303, 330 

Frecr-Sinith, Sir Haniillon, 347 

Fruit preserving, consdcrca, 370 

Fulminate of mercury, manufac- 
ture of, 136 

Furony, -nlate-niines at, 303 

Fumouic, Dr., 355 

Kurni\-al, W. I., 'quoted on kadles.i 
glaze. 168 



Gaillot, M..374 

Gairdner. Sir Win. Tcnnant, or 

pulmonary emphyt^eina, 377 
Galexowski, on the cj-csight of 

workers in tobacco factories, 

364, 365 
Galicia, match industry in, 40 
Galvanised iron, maimfacturc of, 

Gani&tct mining considered, 298, 

Gardener's cancer, 363 
Garforth. Mr. W. E., on rescue 

work in mines, 406 ; and rescue 

tntining, 409 
Gamun, Dr.. medical officer to 

Messrs. Br>-anl & May'» Works, 

■^i^. 47 

Oarnier, M. MaiccI, czpeciments 
upon animals with bcoiine, S4 

Gases, poiwnous. carbonic acid 
coDsidcred, 54-$; carbon mon- 
oxide, coohidcrcd, 5^-68 ; ferro- 
ailicon, 69 ; illuminating gas, 6(j ; 
vmtKT gas, 7(^1 ; poiMonoux gas 
(■iven otf by nickel carbonyl, 73 ; 
ferri corlxiuyl, 74 ; sulphuretted 
hydrogen gas, 74-7 ; acetylene 
gai. considered. 79, 80 

" Gassing " considered, 375 

Geldenhuis Deep, death-rate of 
rock-drillers on the. 361 




INDEX 



419 



HoRg, T. W^ "Immonity ol some 
Low Foims of Ufc from Lud 
Poisoning" by. 139, 140 

Holden, Sir Isau:. inventoir of Ibe 
lucii«r nutcli, 38 

HolL-uid, u»c o( wlittc pliospborus 
interdicted 10,48 

HodMll. his lnv(»tJ)i3tJons oil Irau- 
maliim. t^ 

Hooper, diving fc»ts done by, 109 

HdpiUl Si. Antoinc, Parts, 13, 18, 
206, Z15 

HoniiUI Biminf!. considered, 345 

Hudson Riivf Tun ii«l,coro pressed - 
air illness among the workers of 
the, 98, 106 

HuRhcs. Di. Hugh, his report on 
lea^l poisoning in electric ac- 
cumulator works, 176 

Hugho, caisAons (nst atcd by, 
in making bridge over Mcdway, 

Hungary, ankylostomiasis in tbe 

mincrx in, 314-19 
Hunter, Dr., 96 
Kutchiiiion. l>r. John, oa rescue 

work in mines. ^5 
Hydrochloric acid, nuntifacture 

o(, tjo 
Hysteria, aS. 30, 31, 34. 



llltiauiuting gai, 69 ; acetylene 

sas considered, jg, So 
" iRimonity of some Low Formt 

of Life from Lead Poisoning." 

byT. W. Hogg, 139, 140. 
India, jute exporation frotn, 135 ; 

ankytotomiaiis among the na- 
tive* of, 311, 333 
Indiarabber goods, health of the 

workcrit in the nuking of, 77^ 
Ingliii, Dr.. 211 
" Industrial KfliicieiKy,'' byArlhnr 

Shadn'eU. 133 
Inanity, cau.ted by lead poi*on> 

inc. 2 10 
Inteuoctual work, its eflect on 

health. 8 
"Investigation of Uine Air" by 

HakUoe, 68 
Iriayi, BartbolODuius, 38 



Iron fonndrie)^ hard life of worfcoa 

In, iZj, 2i8 
Irvint;. i>. L. G.. 176; on dealh- 

ratcof fock-drillm, 384 

J 

Jacoud, Prcrfc!4or, quoted on injury 
followed by lubcrculosts, 22 

Jaksch, Dr. von. on poiMning in 
nuonncic workers, sj? 

]amea,Lord,of Hcrcford,.Trbitrator 
oo findings of While Lead Com- 
mission, 161-63 

Japaa, match industry in. ^1.43: 
condition of match making in, 
43 ; attilnde of, toward; the 
abolition erf white phosphorus 
at I he BeriK Congress. 52 ; anky- 
lo&tomiaae among the natives 
of, 3a 1 

{arackMwski, M., 355 
cllmek, of Vienna, his opinion as 
to cause of death in electric 
«hock, 351 

iohannc^urg, dust nlorms al. 193 
obniiton, Mr. C, report on condi> 

tion of cutlery uorksatSolingen 

and Sheffield, 233 
Jones, David Rhys, on reKiic work 

in iniiic^i. 405 
Jones, Dr. H. Lewi*, of St. Bar- 

tholomcw'.s Hospital, 214 
Jonej;, Dr. Kicliar(l,onlhe maladies 

of slale-min«. y>i, 30J 
lordan. Dr. Alfred C, 356 
losscraod, quoted, 31 
jumpers Deep, death -rale of roch- 

dnliers on the, 384 
Jute, manufacture of, 355 ; health 

of workers considered, 356, 157 



Kaffirs, dcatb-ratc of, working in 
mine*. 385, 391 

Kamiuerer, johaan Pricdricfa, 
match work* established in Ger- 
many by, 39 

KeUet, Ur.. on lead poiioitlng in 
tieetric accnmnhrtor workt. 175 

Key. Major Cooper, Inipec'or of 
E«ploaiT«s, 134, 13s 



DISEASES OF OCCUPATION 



Kidney*, effect of had on, 303, 

3it, 313 ; diseaM of, 139 
Ktng EdwMd Bridge at New- 

caatlc. condition ol workers 

when making, ()i.(}4, 107 
Klagcnfurt Wlule had Works in 

Austria, 144 
Knysna wood, 259 
Koch, ProfewiOr. tuhercle haciiiii*; 

di^covvred by, 15, 16 ; on aii- 

tlirax, 134 
Kochcr, Dr., 47 
Kotar gold-mines, freedorn from 

ptilhists among wofkits in the, 

Koppcrbcrg, Sweden, copper 
mines a(, 3ii> 



Lambinel, Dr., minent' dispenxuy 
at LiCRc under, 310, 329, 330, 

33' 

Lacrosse, zinc while used instead 

oi whtlc lend I>y urdcr of, ltd} 
Label lick)ii(^ injurjousucss of, 

Landouzy. Professor, of HopiUl 
l.xnncQ, 3i>0 

Longlms. l*mfcMor, on nickel cm-- 
bonyl, 74 ; on compreuecl-air 
tl)nc», 105 

Loniielongue, his experiments on 
aniouh with tubercle bacilli, 17 

Lailett, Dr., hi^ opinion on lead 
p«lqf,io9 

LMindrlcs, considered, 3S6 ; acd- 
dents in, 387: long boors in, 
388 : inlempinTuice of wockei^ 
369 ; prevalence of tuberculosis 
10 workers, jytuja 

Lead, poisonous character of, con- 
i^idercd, 137-41 ; mining, 141 ; 
smelting and dcsilvcring. 143 ; 
nuiiufaclurc oi red luad tic- 
scri tied, 143: regubtioasinmonu- 
faclorks of, 144-46 ; alcotiol a 
predisposing cause of lead 

Gti»oaing, 147. 148 ; xnacepti' 
lit; of females to plumbi&m, 
149, ISO ; manufactufu of white 
lead described, 151-57: glaie 
u!ied in the roanufactiire of 
pottery. 157, 158 ; findings of 



Commtsuonon, i>9,t6o ;: 
lion on, 161-^3; statistics 
potwning b^t 16^-66 ; Mfaae 
without, conaidercd, 166-M ; 
fil«-culliag described. 168-70; 
Bsc of, in diamood-ctiUtog 
industry, 171 ; use of, in 
polishing and vetting of pre- 
cious stones, 17J : ase ol. in the 
cnamelhng of iron plates lod 
liollow ware, iJ^-JS • ***^ "^^ *" 
electric iiccuinoXalor wotfe, 
175-7'* ; use of, in printing 
works, 178-81 : use of , in glMS 
polishing, iSt ; poiaonlnS by. 
araoti|[ painters conMleredTlu- 
88 : *ubstitute> for, conndere^ 
iw-91 : symploiTLalohtfr of 
poisoning by, iqff-QS; e8«cl cf 
poisoning in prcgnancy,ig8-sM: 
i(^ effects on kidneys, liver, and 
Dcr\-ous sy»leim, 30»-o8 ; pais- 
ologr of poisoning by, 311: 
treatment of poisomof;, iis-is 
Lc Blanc, process of man tiJac lure, 

I30, 133 

Lcclaiic, on the substitntioa of 

zinc white for white lead. i9g 

Lcggc, Dr. T. Morrison, on lead 

Ebonin^. 154 ; bin report «■ 
d poiioning, 179 ; on wool- 

sorters' disca.sc 335 ; hi» report 

on anthrax, ^i^ 343 
Lein;ti.tlre, Or., on the air id 

potteries, W9 
Leubcrgcr, Eiis capciiments 

cartnn monoxkle, 64 
I^noimant. M., tl^ 
Letulle, Professor, 00 tat 

'3. 3"> 
Lcodet, Dr.. on prcvalcacc ol 

tubcrculosisamoag lead worked, 

>7? 
L«wm. Prolesaor, on the o g ^yr ia g 

of IcmI worker*, 199, zoo 
LiutKg. on carbonic acid ponon- 

ing,5s; on »ulphuretled hydrtmm 

gas poboning. 76 
Licbkind, on pulmonary emphy- 
sema In glass blowers,' 377 
Liege, unkylotitoniia^s antong the 

nimers of. 3i»>, 310, jan 
Lille, report 00 the faieolthcf 

house-painters at, 186 



INDEX 



421 



Limoges, porcebun works at, 159 : 
health of worktts, 508, 309 

Linares, 1^4(1 mines at, 138 

l-iiicn workers, disciiscs of, con- 
sidered, 353-^5 

Liiialypin^, 17^^ 

l.isbuin, Iiiitti induttry at, 953 

Littinrgc, ij^ 

Livachc, M., experiments with 
zinc white ana white lead by, 
190 

Liverpool, Diamand Uatch Work» 
of, 48 

Locomotor ataxia simulated, :o8 

Lonjcion, pottery works at, 158 

Loots, of Cairo. 334. 117 

Lorinser, Dr., of Vieanu, pbos- 
phoru.% necrosis first diagnosed 

Lothringen mine, 316,317 

Lourtios, Dr., 403 

Lilwy, on rcspir:ttion, ri6 

LucavChampioanierc, on chauf- 
feurs' fracture, 385 

Lucifer nutch, inventors of, 37-9 ; 
indu'^try of the maldiig of, 40-3 ; 
doscription of manufaclure of, 
43 ; poiMmous effect of the u.sc 
of phospborus, discu««ed,43-8 : 
ilt-hcalth of the workers at the 
works at Paolon-Aubervillitrs, 
4g ; ucc of sesqutsulpbidc of 
pQOsphon]&, 4Q-S3 

Lurgan, linen industry at, 353 

Ly<£Ule, deiicribed, 133, 134 

M 

Uacatilay, Dr. Donald, 276, 378 
Uacdiarntid, Dr., quoted, 138 
Uackemie, Dr. A., of Le«ds, 410 
Uaclood, on dccomprenion, 107 
Macnau^btoti, Dr. iSoorge W. F„ 

on caisson disease, 103 
UaiUssez, Dr., on leiid poiaofung, 

UaUen, Dr. Walter, on aniline 
poisonlnR. 127 : on di-niticv 
beoxene poisoning, rsS 

UaaguieM, poisonous cficcts of, 

Mann. Dr. Dixoo.on lead poiscnuDg, 

»S 
Uaoouvri«2, of Valenciennes, 330 



Marine service, ccntklered, 396 
Marix, Dr.. quoted on slatiiDei of 
soldiers woaoded in the chest. 

M^riotl, Mr. Hujjih P., oit tem- 
(H-r.iture^of Sunth African niinrK. 

Martin, Mr. Joseph S., his report 
on health of workcrsal Tanslock 
arsenic mines, 317 

McKinby, Fleet -Surflcon ArchJ- 
bold, case of diving fatality re- 
counted by, 1 13 

Medwiiy, ciussons first used In 
makinK bridge over.u 

Meningitis septic, canseo by lead 
poisoning, 51 

Mercniry, poi.«onou!i effects of, con ■ 
sidcred, 113-26 

Mericourt, Leroy dc, on dangers 
incurred by ^ipougc-divcrs. no 

Merionethshire, ilalc mine^in, 301, 

3«» 

Metallic dust. 311 

Mcyhofer, on cataract in glass- 
blowers, 379 

Middlelon St, George, blast far- 
nuce» at. 60 

Mies, lead smelting wortts at, 14J 

MillMone building, 306 

Miners' aiiceoiia, ue Anjooiia 

Miners' nyitagniiu, 273 

Miners' phthisis among cool- 
miners conuitercd, 267-73 : 
among South African gold- 
tnincrs, rjif-86, 390-93 ; umong 
the quarti mUicrs of Bondigo, 

295-98 
Miners Phthisis Commission, 3lU 
Mining, ice Coal Mine^ alia Gola- 

mining 
Mlrrot gilding. 325 
Mtrto, on the pcnctratioo of car* 

ban monoxide into dead bodies, 

65 

Miscarriage, load poisoning, i8(S, 

198 
Monmouth, tin>]>latc mills at, 339 
Monmouthshire, high death-rate 

from phthisis in ininera in, 

269 
Morvcau, Guytoii dc, on the s)it>- 

stilutton of line white for white 

lead, 189 



422 



DISEASES OF OCCUPATION 



Mmnv. Dr.,qaotedon rrauRiatiun 
ana luherculovl^, iS ; his ofiinion 
OR lead cncepliatopalliy, zo6, 

Mocssaglia. A., on faliKuc. 7 

Mosso, PtofewMW. of Turin, his 

cxpcrinu'iiU upon ^Lnimals with 

acetylene. 79 : on " moiint^in- 

nckncss," 117 

Uotoroir driving, dan^nt of, 

S&4 
MoH. Dr. F. W., 73, i« note, 74 

MaunUin-^cbnc*.s "5-19 
Uiilln', on mpiriilion, tiO 
Munich. Dr. L. V. Stubcnraucb of, 

45 
Muscular strain, effects of. 9, 10, 

ti 
M>xr$, Sni^coD.onlbcuniiormof 

soldiers 3QS 
Myrhanc, 139 

N 
Naphtha, its iise in dry-cleaning. 

Na^nilh, experiments upon ani- 
mals with carbon moaooddc, <i6, 

Newcastle-upon-Tyne. Royal Vic- 
toria tnf rmjtn- at. loy 13 ; deaths 
from phoiphoru» poisonlne in, 
Sp, 53 ; cofi;(lructio» of King 
Edward Bridge at, 91 : lead 
woris al, 150, r^ ; rilunibi«n 
amou^ twinlers ui, 180 ; Arm- 
strong College at, 314: elDctrk 
railwa>':i in, 349 

New Vork, underground railways 
oC,i4i 

Nichols, Dr. fl. ]., quoted on 
.inlbracahis and tuberculosis^ 
370, 971 

Nicholson. Dr. T. Marshall. 410 

Nickel ciu-botivl, poiMtnous g» 
given off in tfic manafacture or, 

73.74 
Nicolai, quoted. 3a 
Nicokt. Profcwor. 39 
Nitiic acid poisoning, 1x4 
Nitro-bcnxene, 12$, 139 
Nitrogen oxide, deaths from the 

fames of, 976-78 
Nitro-glycerine described, 133 



Nobel. Aliied, nitro-jCly 

manufactured b>', 133 
Normandy, intemperate habilK ol 

woikiiiK '■'l^>^e« III, 147, i^Jt 
Norway, export of matctid(r«n.4a 
NutemWg. match faclocic!»at,4o 
Nystagmus in aiiDer«. 373 



OakwDTlh House, 3S 
O'Kcliy. Dr., rescue work by, 
Oldbnry, manufacture at 

phoQphoro» at, 36 
Oldciidori, bis report on the at 

gnndeis ol Solingen, 233 
OphlhaliiiLa. electrical, 3>4 
Orange Ri\«r Colony, di^th 

among native miocrs, 3^ 
Otiolcnghi. Ins tspcrimcnl* opon 

animals with acelytene, 79 




Paardebcrg, lyddite used at. 134 
Pain IS sign of disease. 34 
Painters, prcvatcnce ot lead 

poisoning among, rSa-SS 
Paints, dangers of (|aickly-dr>-iiig, 

Pantin-Aabervilltem, matcli works 

at, bcallh of the workers at, m- 

J I ; tobacco U'orfcs at, 3O4. 20s 
Para red dying, 136 
Paralysis frooi lead poiwxiuig, 

207, 308. »I4 
Paralysia, siniulaied, aS, 29 
Pari^ match factories in. 40 
Parkin, Dr. Alfred, expcrimealt 

upon animals with lugh pre*- 

sure* Ol ox^eu, 98, 99 ; •■ Tbciis 

OQ CaJssoa usease,' b; 
Parooa 
Parsons, 

for workers in shoddy I 

3<« 
Pasteur. DAlc birtfaptaoe o4. 4OJ 

on anthrax. 334 
Paxteur Insbtule, 190 
Paterson, Miss, report on female 

workers in lead factories by. 

PuiuTconstantin, on the offipriag 
of lead-workers, 199 



1 



tjssoa usease,' by, 109 
00 ank^kstoittUjis. 31Q 
I, Dr., his reoonuBCCMUttMMH 

- ^aciock.^ 

! o*, aoa^ 



INDEX 



4*3 



Peacock on miners' phthisis, 280 

Pearson on miner*;' phlhixi«, aJlo 

Peltom Foil, incident It, recounted. 
61 

Pcnrhyn slate quarries. 301 

Pcraoncito. Dr., on ankylostomiasis 
in miners of the St. Gotbard 
Tunnel. 313, %t.\. tio 

Persigny, U.. aliiindu of, oa itic 
use of wliitc k-iwl, 1S9 

Pcrroud, his invcstiKal)on:« on 
phtliius among Ihe uiilurt on 
tlic Rhone, IS 

Persia, imporo wool from, 336 

E'crsiau pottery, t6S 

Pen], mining in, 1 ift 

Petrol, poisonous vapours given 
off by, 85. 8A 

Pho«phorir< dc^scrihcd, 35 ; manu- 
facture of wliilc, 3^1 ; U5C(I in 
tlic maniifaclurcof malc]ics,36: 
poisonous qualities of, 36 : com- 
mittee to inquire into poisonoas 
cficcts of, 36 ; effects of its 
fuiDes on the tcetli, 43, 44 ; cx- 
psrimeiits upon animals with, 
45 ; affections arisinc from, .f6 ; 
statistics of poisoning fioni, 
47, 48 ; use of scsquisulpliidc 
of. 49-51 ; prohibition of. $3, 

Phosphorus necnMis. or " phossy 
i*vr," 37, 44 ; described, 44, 45 ; 
immunity o( animals from, 45 ; 
»tiiti»lics of, 47, 50 ; treatment 
of. 5* 

Petrow, hi« c3cp«riments on ani> 
mals with tubercle bacilli, 17 

Pbttiisin. i« 1'ubcrculodis 

Pidoox. Dr., 178 

Pitch. 33a 

Playfair, Dr. Lyon, 405 

Plumbisin. Kt Lciid I'otsoning 

Pncumokonioscs. 247-310 

Pneumoni.!, injury M a deter- 
mining cause of, CMiMdcrcd, 
3i-«3; diwl as a (^^cdispoiiiig 
cause of, 344 ; among miner}, 
jqoHM. J02. 303. 310 

" Poisons IndustrieU" quoted, 84 

Pol and Watirllc on compressed- 
air illness, 93 

Polishing of precious stones, 172 ; 
of metals, 330 



Pollcnder, batillm anliraci db- 

covcf od by. 334 
Pope. Pearwn A Co,. Messrs., 

collieries, 409 
Posoott, W. G. T., p-itholoRist to 

the Johannesburg Hospital, 

Pottery manufacture, (57 : health 
of workers coosidcrcd. 307—10 

Pott's diMasc, 30 

FVcshcl. his large match factory 
in Vienna, 40 

Preltiii on pulmonary emphy!«cma 
in glaw-blower», 377 

Prevost, i»ro*cssor, 6t Gcoe"ra Uni- 
veT>ily, 350 

Prindna works, hcollh of workers 
in, r78-Si 

Probstmg, Dr., oailisi, 379 

Proost, his opinion on the manu- 
facture of tobacco causing dis- 
eases of the lungs. 164 

Prussia, statistics of accidents in 
coal-mines in, 375 

f^usstan blue, manufacture of, 77 

PnrdOR, Dr. H. S.,on the maladies 
of linen workers, 354 

Putty powder, 181 



Quilimanc, death-rate among 
native minen from, aSg 



Racing of grindstones, 230 

Rag sorting, 260 

Ramm.izinl, miners' phthisis de- 
scribed l^, 180, _307 

Rand miners* phtbisis, *76-i!s 

Ransomt, Dr., on the Committee 
appointed to inquire into Ukc 
ventilation of factories, i$t 

Ravcnhal of Penusylvania, 337 

Raymondaud, Dr., 309 

K<.'(1 lead, ue Lead 

Redruth tin-mines. 300 

Reichenherg, polishing industry 
at. 173 

Relm, German surgeon, on aniline 
poisoning, 137. 138 

Rescue work in mines, 304-12 




424 



Ridley. Sir Uatthcw White. Com- 
mittee appointed by. to inquire 
iolo the duigcn vttciHlin)^ lltc 
i>« <rf phaspDoriu, 36 ; quoted 
OH lead EX)j«oniaf;. 153, IM 

Rigolot, M.. 19a 

RipL-rt, M., tiiM cxpirimenU npon 
animaU, 30^ 

Roberts. Sir William, on Ihe Com- 
mittee to iiiquirc into tlie venti- 
lation of tiicloric*, 351 

Hobcrt^haw, Dr., on (tcath-nUc of 
Canrster min<.-TS. 398 

Robinson. Dr. Wni, 379 

Rocliesler, caisMtiK hfd used at, 

Rock-driUer3, health of, 283, stl4. 

Rhodesia, 189 

Rogers, Mr., on lead poboning, 

<S7 

Rdmer, Stephen, inircntor and 
inanDfacturer oi luclfer matches 
in Vienna, 3^1. 40 

Roquet, M., 901 

Roscoc, Sir Henry, Comraittoe 00 
the condition ut ventilation of 
factories, 56, 351 

Rorttock on truimatisin, 15 

Royal Victoria liilirmBry at New- 
castle, 10^ 13 1 deaths from 
pbosphonis poisoninj; in, SO, 
S3 ; cues td plntnbtsin in, 150, 

■95 

Rudolf, Ur., manager of the 

Sc^iron-Brcnnbcrg Colliery, 319 
Ruhr Valley, caal-minn in t1i«, 
3»4. 315 



Sadler, Uiu, Inspector of Fac- 

lories, 387 
Soilont, conditions of life and 

bcaJtl) of, 396-98 
Saltasb, caissons used iit, 94 
Salt cake, manufacture of, de- 

scribed, ik>-J3 
Sklvetat, M., 168 
Siasora. Dr. C. L., on deatli-ratc 

of native miners, 3B5 
Santcsson of Stockholm, cate of 

benisoe poisouiiig reported by. 




DISEASES OF OCCUPATION 



Sauria. Charles, dudenl at 

inventor uf a lucifer sMldt, yf' 
Schvelc's green, arseinc used in 

in^mulacturr of. ;i6 
Schlockow nn dJscaset of nac 

workers 377 
Scb&nbeln, gun-cntton discovcrtd 

by, 133 
School teachers, liealtb of, au- 

sidcred, 363 
Scbi5ter, of Vienna, red pbi»- 

pbonu diKorercd by, 35 
Scnr&llcr, H. von. on cnsMa 

worlccrs, tog 
Schulc. Dr.. of Berlin. 37% 
Schultx on the |>cnctratkoa of car- 
bon rooiioudc into dead bodiak 

64-ft 
Schweimtx. Dr., on the e ym l^ 

of workers in tobaceo factona 

ScUto, of Milan, anti-amhm 

scnnn invented by, ^3, ^j 
Scott, V. H.. on laligue, 8 
Scranton. health of minors at, X70 
Sejoamcl, Dr., on the matadics of 

slatc-mincr«, 303 
Seltoiao on lutierculosis in 

miners. ±^ 
Sci^iiisulphidc of pbosphonui 

instead of white ptiopboms for 

matches, 49-52 
Sevi-ne, M., use of sesqtasiilphiclt 

of pbosphonis for matches cfi» 

covered by, 49 
Sevres china, 159 
Shadwcll. Dr. Arthur, ■■ lodastriil 

Efhcicncy ■" by, aja 
Shears, Dr., on the eyvsigbt d 

workers in tohacoo faotorld 

364 
Sheffield, filc-colting iadmtry iL 

170: cutlery nuu)uf«clut« M 

considered. zn>, 231 ; Solian 

compared witn, 333, 33^ j (£^ 

trie wcldinS ill, 354 
Shidlowski. H., diving appsnlni 

invented by. iii 
Sboddy industry considered, tt^ 

61 
Shuttle making. 158 
Siberia, 336, 337 
Sicily, sulphur mines In. jta 
Skleroiis, 147, 311 



INDEX 



4«5 



Sici^l. largo match factoi^ of, in 

Vi«nfu, 40 
Signalmen, heaJtK of, considered, 

Silicosis, 347 

Simoois. Mr. Otto, on liquid-uir 

ri»ctie appeal u», 406 
Simplon Tunnct, making of Ihc, 

3<-4 

SlaK crushing, 3to 

Slate quairyinj; in mtncN, 301 ; 
allmcuts of workers, 302 ; mala- 
dies of Frttich miner's, 303-30S 

Smith. Dr., on compressed-air ill* 
nest.fp, 104 

Smith, George, oiilboemployment 
of children in brick)Mrds, 380 

Smilh, Lorrain, Professor. hU ex- 
periments upon animals with 
expired air. 56 ; effect d higti 
pcetsurc on the btood, 99 

SiidL Or. E. HukIi, on com' 
prc»scd-air illnvM, 91, 03,97, 108 

Sncll, Mr. Simeon, 354 

Sobrcn>, A., nitro-glyccrinc dis- 
covered by, 133 

So<la, miuiulacturi: of. docribcd, 
iao-J3 

Soldier*, life of, considered, 393 ; 
health of. 394 ; phyaksl training 

of. 395-96 
Solingcn, cutlery manufacture a(. 
2^1: compared with Shcftivld, 

»33. »34 
Sommerfietd , statiKtiot q uolcd from 

his book on diseases of occupa- 
tion, 247 
Soot, injiirions effect of, 161 
Soot, iiTttation caused by, 163 
Sopcf, Dr. G. A,., his report upon 
the air and dusit of the New 
York Underground Railway, 
243-45 
Sopron-Brennbcrg, health of 
miners sit, ^ ; aabyloslo- 
inixsiy in the miners at, 314-19 
(South African KDld-mini.>&. ticattli 
of n-orkeri in. considered, ijf* ; 
imkjrlostonuasis among the 
miners of, 331 
ISponjtC5cekcn, tio 
L£()tiife, Mis« Rose, tier report on 
titi-plale w-orkers, 340, 373 
Staffordshire, polteriu of, 158, 159, 



i6t, 164 ; death-rate of potters, 

3*>9 

StesTenxan, Dr. C. Stanley. 60 

Steel grinding 330 

Stephenson, Dr., his report on the 
ventilation of cotton mills, 351 

St. Gotlutd Tunnel, ankylosto- 
miasis in the raincrsof the, 312- 

14 

Stewart, Sir Thomas Gnunger, on 
fatigue, 8 

Stiles, Dr. C. W„ on ankylosto- 
iniFisi\ j,!^ 

St, loicph'alatc mines. 303 

St, Louie IJridgc, MiKiissippi, con- 
dition of workers at, 94 

Stokc-on-Trcnl, potturjr works at, 
!58: Court ol Arbitration at, 
161-63 

Stockman, Profcsaor. 337 

Stockton-on-Teen, Mst lucifer 
match made at, 37, 38 

Slone:tnsons' plithisis. ;;to5 

Strasburg. m^tch factories in, 40 

StrasMnan and Schultx, on tJie 
penetration of carbon monoxide 
mto dead bodies, 64-6 

Stuart. Dr. I. A. E., on the health 
of t>lanket-iloven(, 86 ; on the 
maladies of workers in shoddy 
factories. 361 

Stubcnraucb. Dr. L. v., his experi- 
ments upon aniniak with phos- 
pliorus, 45 

Sitiltgart, match factories in, 40 

Styria, match industry of, 40 

StiCar refining, 373 

Sulphuretted hydrogen gas, 
poiMinous effects of. 63. 74-7 

Sulphuric acid, manufacture of, 

120, IJ2 

Sumatra, petrol embarked from, 86 

Summons, Dr. Walter, on the 

health of miners at Bcndjgo, 

395. »J7 
Snraniica, smelting works at, 319 
Sweden, match indufitry of. 35: 

export ol matches from, 41, 

Switzerland, compensation of 
workers in, 36 ; phosphorus 
necrosis Among match makeri 
in, 47 ; use of white phosphorus 
interdicted in, 48 



426 



DISEASES OF OCCUPATION 



T^yracb, SargcoifUajor, on an- 
IgriostoaiiaMA amoDg soldicn, 

317 
raDqucic), Dr., 178 
Talbvn, Dr. John, his ^Uti^tics 

on zinc workers, sxt ; on the 

highdcalh-ntcof dcal-griadcrs, 

333 : hi» Htatitlicsoo deatli^ide 

from cancer in chinmej'-swoops. 

363 ; on death-nte itota phlhui* 

in miners, 168-70 
Taviatov:k, illticiUli o( v.'orkers at 

the arsenic mines at, 3 17 
Tca-tutineoontidered, 3A6 
Teissier, Profc&sor, quoted on 

tuberculosis, 14 
Tcleky. Dr. LudwiK, Iiis work on 

tlic inatcli*iualun£ Indu^lry , 40, 

4> 

Tek^raph cl«rk», tieallh of, con- 

siikred, 36) 
Temperature in mines, 287 
Tonholt. Dr.. authority on anky- 

loslomiiiuN 314, 316, 330 
T«tanu& in jute workcn, 3^7 
Thcniird'a iiiclhod of white bad 

manufacture, 155 
" l'he»i& on Caiswn Disease," by 

Dr. Alfred Parkin, 109 
Thorpe, Professor T,, on Com- 
mittee to Inifuiic into the 
Dangers allendtng the Use of 
PliosphoruSi 36 ; quoted on the 
effect of thv fumes of plioft- 

[>horus on Ihe teeth, 43, 48 ; on 
i;;kI poixming, 140 ; on White 
Lead Commission, 159-163, i8j 
Tin-mines in Cot^wall. health o( 

workers in, considered, 300 
Tin-piate mills, turd and un- 
healthy Ufe of workers at. 339- 
341 
Tirelli, U. L., on ankyloitonuasi^ 

33' 
Ti£»t, Dr., rescue apparatus m- 

venlcd by, 411 
Tobacco lactones, health OJ 

v(Orkcr» in, 363 ; State mono- 

poly in Franc*. 165, 366 
Tonitc, m 
Tracy. mS*, 387 
Transvaal. i88, 193 



Trap-drummer's netirosts. 362 

TrttutKalifiR, a» n de 

cao&e of tuberculosis, ta-M 
pmnunonia folluwing, 21 ; di 
Detes due to. 35 

Treillc, M , report on white lead 
tndusltv by, 147 

TrilUI, I^rafe»or, lead le»l du- 
cm-crcd hy. 163, 184 

Tuberculous, injury as a dder- 
mining cauic of. considered, i »- 
16 i cmperitncnts on xnimat). 
16, 17; Dr. Alosncy's 01' 
on. tS: iajury prcf 
way for Iho reception 
30 ; clainu for covni 
considered, at— >6 ; sunt; 
31. 32; amoRj; filc-cultent, \i 
amonff printers. 178-79: 
as a delemiining cause of. 
4S ; its prcvAleiH:c 
cotton weavers, 249, 250 : bm^ 
miners' phthisis con5klcnd. 
^''•7-73 ; Rand miners' phthbii 
con<.idofcd. 379-M5. 293 ; mincn 
phthisii, 295-500, 30a; stone- 
masons' subject to. JOS : ntill- 
uone biuMcrs WDjcct liv 
306-7 ; its prevalence amooc* 
[aundrj workers, 39D-91 

Tunstall, pottery works at, 15I 

Turoau, 171 

Tync, condition of shipbuildii 
an the. 5 ; hridjie making 
9'. 9a. 93. 97 

Tyneskle, chemical indnstry 
ISO 

Type-founding, 178 

Typists, health or cooudered. }ti 



Vahlceo, on nickel carbonyt, 7 
Vauginat. Lieutctiant, rescue 

paratun invented by, 411 k 

Verbacghc, Dr. D., his report 0? 

the health uf hoa»e-pain(cri of 

LiUe, 186 
Vernon, Dr. H. M., los 
V'iettua. lucifer match indastry in. 

37. 38 ; decUne ol miitch indr"— 

In, 40, 41 i comrai&sion on 

industiy at, 144 




Von Krausc. hk experimenH on 
animuli wilh Koch's b.iciUiu, 
16, 17 

Vo»s on liauinalism, 15 

W 

Wacbholx, hb experinicnu wilh 

carbon monoxide, 64, 
[ \Vaiiiwri>:ht, Dr. F. R., oburra- 
} lions on causes of "com- 

{ p(cs«:d-uir illncsa," 97 ; on 

decxMnprcuiDn, tor, 108 
WainwTtgtil, Dr. J. «., quoted on 
I anth^lco<n^ and luoercnlosis, 

MO, 571 
Walker, John. )>r»t inventor of the 

luctlcr uL-ttch, 37, 38 
WaJlcr, Dr. G., stalhtics on com- 

prnscd-oir lUaess al the Itiii- 

nelling work*. Amsterdam, 105 
Wa]]>|»per ruining and colooring 

considered, 33^ 
Walcr-spraying m mines. 315 
We^cr. hts exnerimenls upon 

aninuk with pQost>horus, 45 
Warringtoi), Dr., of tno Liverpool 
, Unirersity Patholo^cstl Labora- 

tories, 20^ 2 10 
Water aas considered, 70-73 
Watfcin, Mr. R. J., 2i» 
Wedftwood china, 158 
Wcicnait, on fatigue, 6 
Weir. Dr. James, on lianoiatism 

and tuberculosis. 15. i(S 
Wetdoii process oj RKuiufsctmc, 

I30, 131 

Westminster House, exhibition of 
leudlesfi gbue ware al. 166, 167 

Westphalia, ophthalmia among the 
4:ocu-min«rs of, 374 ; ankylosto- 
miasis in the minerk of, 314-17 

West Riding of Yorkshire, bieh 
dcath-rjlc from phchi«i.i In 
minen of, 164 

Wheatley, Dr. James, quoted on 
liealth conditions 01 cotton- 
weavers, 149, i$o 

White, Dr. Sinclair, statistics on 
sice I -grinders. 231 

White, Dt. Prosscr, on di-nitro- 
benzene poiacniog, 129 



White lead. U4 Ixad 

White Lead, manofactDrc. 146 ; 
Commission. 148: ftadincs of, 
159, 160 ; arbitration on, lot-^, 

•' White-swcUiog " after an injury, 
14 ; compeoutioo for, in Ger- 
many, 15 

Whymper, Mr., report on linplalc 
industry by, 340 

Wteluyk quoted on petrol miner*. 

85 
Witu-alctsrand, gold mining at, 

*8l. 311 
Wolf-Fivmer on fatigue. 7 
Wolvcrlwmpton, enamelling in- 

dirstty al. 172 
Wookoilcrs' disease, irr Anthrax 
Workmen ■> Compensatioa Act, r3 ; 
claims for tut>crc»lo^i'i followed 
by mjury considered, 31-24 ! 
simulation of disease con- 
sidered, 26-35 ; lead-poisoning 
compentatod for under, 167. 
1H5, 104: poisoning hy Afri- 
can boxih-ood compenxilcd for 
under, 359 : miners' ailments, 

Wnat-drop. caused by lead po«son- 

■ng, '47. »07' 'o* 
Writers' palsy considered, 360 



X-ray workors, health oi, 356 



Yorkshire, gsiistcr miniDg to, 

J98 
Young, Dr. T. F., 358 



Zenker. Dr., 964 : on sidcrodi. 

3" 
Zinc smelting work>, health of 

workers in, considered, 221-23 
Zombii. Dr. Stef., 00 Ihediseases 

M spoogc-divcrs, i]0-t3 
Zuntzon respiration, 116, 117 



nt9ttabmn pitm. 



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INFANT MORTALITY. By Giorcb Nswuan. M.D.. D.P.H., 

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THE DKINK PROBLEM m its MBDtco-SoaoLOctCAt. Asncn. 
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DISEASES OF OCCUPATION. By Professor Thomas Outb. 

M.A., M.D., LL.D., F.R.C.P., Phy«cian, Royal ioBnoAjry. NewtmMh- 
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eliclncdil ihock, etc. 

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COBABU' By CHA8L.E5 P. Chuj», B.A., F.R.C.S. I>«my Snx 71. U-« 
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which forgical opeiatioo tfr-day oSen in U» tmunenl of Caoeer aa .._,iiiJ 
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MUideTatioB of modern viewi of the nurnre of Caoca aa well aa &aa ^ud 
Kanlts obtained in il> Itralincnt, the improTeineiit that might be MBlkiaMri, 
WCK It not for ihe deplorable i^ntiiancc tliai ciMtiof iiaaaily NgBi m>i1 the '-bw^ 
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THE HVGIENICS OF EDUCATION, MENTAL AND 
PHYSICAL. ill- W. LcsuB Mackenzie. U.A., M.D. O.P.IL. 

U.R.C.P.E., F.R.S.E.. M«dic>l Urmbcr of the Loul OoreniMHil BmH 
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Thti book aima al prcseniiog the pcDblem of Edncadon fro<n the « ^ irf p?*i 
of the Pbytician. The child, aa a ctowbig mind in a gnxrinf; body, ii fatMcnri 
lo Mr we*. Edacaiioo is conceived as at once Ihe upertnieiidciKC of aujinl 
tad tim "prOTiMon of u envitQnDicm." The leailing tncotaJ pioeaia, d( 
gnoadwock of atiquliltioB, fttl^ nmial and {Ayiical. an iliii«iil ia ibt HA 
Mrecenl rcacarch. Consdcmaai ii alio e^rm to the dm nd nottid le^k 
tt orerpteuure, abnoimihtia ot the orE'^i of setue, nnriKl ^''i*r ^ tm ite 
fldiKational lift from birth to adolescence, the hoLlth iwitfllriwfia of life 
eo-«diioaiioB, and other pnetieal prohltn*. 



THE PREVENTION OF TUBERCULOSIS (CONSUMPTION). 

By Arthur N«wsHcn.MB, M.D.. F.R.CI'., MpJitJ OfBecr of H«&Iib 
or IlTi);)itan 1 PteiidefK ol tha IncMponlcd Society of .N!tiUcal Oflicer* 
of IlcftUh I |399'I90I>) i Exuninei in Public Iltalch to the Uair«rati«s 
of CaiiiUitltIc and Victoria: late Examtncr ia Suic anU Picvaniivc MtdKio« 
to Ihc Univcrulies of Loailnn and Oituid. Demy Svo. 

The maJB abj«c( of this booh ic prartial. It ia intauJnl aa a fukle oot only 
fo( medical oflicen of hratlh. but for alt r Tigaged, wbclhti oo buejnlal conimitln* 
or loisl Koteiniiii; IxkliM, id wltnlnitliulive sieaiures foi the cootiol of tDbaculoaa 
and the B^Tuicemcnt of the public health- A large patt <if tbc book ihetefora 
«il! coniitt of a diacuwiiiti ttl moMuM of tacitirj K-icrn aad of naeiai hnpnve- 
Dkcnl wtucb ut Uw chief iDdircct BMM : and <>i incuurct inch aa Doli6c«dm, 
vbitini: and aJTiiin^ paUeou, di^nfeclion, tuiatoiiuin [i<atmeni and iTuuingM 
paiirau, and hoapiial Mre^atloo of adiaitc^ paticnu, which aie the all- 
Itnpnrtant dir«cl ninnf of coRlroUii^; Ihe dii^atr. The trlaCiTe impottknce of 
the (bi'*« and allied rneuuiei can onli' be undentood wbcn the patboJocf and 
cauutioD of tubeiculoait an known. The prcimtioo of ContuBBpliOB mvA b« 
baled on a kaowlaj^ of it* autatina. 

NUTRITION. B7 Ralph Vinceht, M.D., B.S., M.R.C.P., 

Phywi.in lo (he Infanta' Hospital ; lal« Senior Resident Mr<lical Oflirer, 
Queen Cbarlolle'i Ljingln Hospital. Demj Sto. [/m frtfantlitm, 

Nmiilion, as the iaict ol national power, b Ihc leading feslnie of tbii 
trork. The hckllh and iltengtfa of a nation are pticnariljr drlciminrd bj iti 
power of reproiluclion. Thr rnrmt of h^alihy inf^intt aod the ptfTcntJoa of 
octeetiTf Wrucnitf iri^icE frnm milnuirilion ai' f.f cardin-il wonomic impotian**. 
The procnl oooditjani, so lerioun)* tfatmlccicg ibe welfuc of ihecoutitiy. and the 
practical rnncdMs are dlscaiud in detail. Diet, in telation la nnttitioa wmI 
ttiucii:r«, nrcn— rily fKeivea apecial aiteatJon. 

DRUGS AND DRUG HABITS. By H. SAiNSKUnr. M.D., 

F.R.C.P. DcmySvo. \/h fnfaratAn. 

Od the iDbjcct of drug*, k> ailed, Tetf nroncoui conceptiont prevail. For 
lome they are ij-flon>inoiii with poiaona, vet muij forget thai thii latlei leroB 
hai 1 sifniiiance whirh U relative "nty, ano few, outside i>ie ranki of thou who 
^^ practue mediciDe, rcaliie how difiiaill il ii lo isolate druga ai a claix, and lo 
^^L (tanae a definiiioo which shall Btis.fiutori)]r separate them boat alimecti. To 
^^B draw attentioo to ihete miaconcepiioiii ; to pi>!nt out the more pnriM telailona In 
^H which tnedicinienti i-and to diieue, anil ihr piciblenu which aisease puta before 
^^1 ut for w>lu lion ; tu m^ke ptmninent the be i tliAi drug hatiiit — inclLiding the nte 
^V of tea, cofict, and lohatxo— aie but iwUocc* o^*l«w which ia (undamcDtal, aad 
iDtlic man i fatal ion of which lenpnament and educatiim pla; prii&ai; paiU,— 
these aie the pu(po*flt of the preant volume. 

AJR AND HEALTH. B7 Ronald C, MACrin. M.B. DemySvo. 

This book deali with the phy»<a] and chtmicat properties of air, pattlculaity 
with refErence to hralih »[i<! di'-Tiw, The JAJ^iology of respiratioa will be 
coniidered io ila pnuiica,! L<:kiii^|;&, and ctiaplcrt will tic df^roleil lii the quntion 
of climate mad (o rtlivant luntious of duit, foci £<nni, aiibomc epidcnuo, etc 
Ventilation will be fully diKua*c<Ji both in it* pniaic and public Mrrri^ 

UNCTIONAL NERVE DISEASES. By A. T. Scwofield, 

M.D. DemjSvo. Js. 6d net. \T» firtfwhim. 

Thit book if called fi>r, DM only oa aecount df the i(>eiMainj> iniioitince of 
I the •.u!;jcv(. but beca»w the treatment of these diawaes ia rajiidly altering b 

^^ chaiuter. and is tikine more acouni of the paychie factoiBand iifing leu tires 
^H vpon the physical. The priscnl work >cel.i lo pteieni the newcu ^w on ihii 
^f aubject, and to l>r a ptaotical han'lbook to medical paycfao-therap-utics a* &r at 
^^ tber *tt appllubk in ihe^ iliacntcs. At the famie time, vaiiowi toima of qtiockeiy 
tuo pseudo-icli^ioua *vicue»o4 Ucalsicut will favdMcrdMdiod their erili pointed 
ort. Slvi.*! aliuMMiwiilatKibc uuic lofuacikiMloerredlMMetiD chikjrca. 



D 

f 




ABNORMAL AND MENTALLY DEFECTIVE CHILDRElCl 

Tfltm EDUCATION AND TRAINING. By !l»x«v Aswur, MD, 
F.R.C.P., Lcciutvr on DitCMC* of Childreo, VioUnul Unireratr. TOa^ 
Uat«d. OcmrSvo. {fm 

ChMitn didtt from on« uoibn. Is pfaydcil. tn«nu), u»d nwckl 
An tticmpt u mide tu detcribe those woo arc «<-ll brlnw thr ""■^■l BB*,ai 
the fSeci which «<!ucalion and traioin^ hu upon ibeii defeetK. Hew«de 
diililrrn, the dull t.ai Wkwiid, thoM with miaor mental abnoroaEitiMi m 
*ntl M the tuse and vui«l cUii who are feebly pAed ■■ reprd* ommbI 
power*, come in for oontidcralioa. Refereoce is alio made to "mtutt 
iBibedlci," and Ihoae with convaliive dliordcii' ; while deaf'inuic* and tboM with 
speech defect! are alto dcitt with. A ^ood deal of (pace ia gtren to teniae ^ 
■ncBiml otpujciea ol dcrettivc cblldten and to their edocadoo and training 

THE PRINCIPLES OF VACCINATION AND SERUU 
THERAPY- By AtXAW MAcrADTKN, M-D., B.Sc, F.l.C. Head ol 
Bacteriological DcfMntmeol, Jconer lulitute i FuUertaa Protiamar «l 
Pliyviology, Royal Initllutioa. Demj' 8vo. \'\\ /iiiJmiI'w. 

Tie puuitic doctrine hai mrolutiofliwd the raoeeptku of dtMaj« 1 1 ria 
and ihe mdhod* (« their prevention >od ticalmmL Tbe koowledee ihat IIm 
been gained of ihe tulurc uid mode of ■otion of the living ^enu itiaj iniadc itir 
body anil produce diiraM hai led lo the moU notable advances in medkiae, 
tu^riy , asd by^lenc. One o( the moat Uiciruttng chapten of iiifiliial d ia c w ay 
a thnt retaiing to the oolutrao of a dfk tb«Bpy, bated on icieiltiAc ObMnilfci 
and cxpciiiucnt. The pruent volume tcktca, wiiboHt uadae tedminl decsll, ik 
iKU and conception! upon which the eoethods of Senim Tbenp7 and VacdMtiDi 
ate boMd. 

THE INSANE. By Gborob R. Wilson. M.D., F.R.S.E., ett. 

Illuitrated. Dewaj Sro. (/•> /vrjmr^Htt. 

This book ia intended to be an InBoduction lo the ttudjr of liuaolt)', ud a 
■pcdaity deigned for the raedical ttudcnt, Ihe geneial pracdtioDcr, asd tkr 
wnotad layman. It will deal with the uaiuie and mcanlDg of Insanity, tid 
with the huiory of the subject ; with I he camct of mental ^•r^n, its tnqoaa, 
and ill impotttafe oi a ceaal f&t^tor; aad It will give a de^criptioM cf lit 
Tarietie* of Iiiwnily now rceo|^i«ri] by iprciali^U, tnrir pathology ^td ^k 
danificatioo. But it will aim chiefly ac pmdical rather tMa theox ti cJ ttim, 
and will prcarat eaan of an vaiietiea, ■«p«clally Ea (li« early Ku«a, nd wfll 
rtiiniii their managemenc and Creatmeal. The book wiU b« unauated by 
Jllgianii and photograph*, 

A TEXT-BOOK OF HEREDITY. By ARtaioAtL Rbid. M.B., 

F.R.S.E. Dt'inySvo. ['ii /ii/airfiii 

This volume corers the whole field of heredity, but rinrrlal Mtantioa it faU 
to pntciical pfubltmi iiTrciing hutn&n beingt. Among the niibjecta daalt wlA 
are the method of the crolution of the race, the roeihod of the devdopneDI rf 
the iniiividual, the distinction between ttic different clai»c» of a^a at tbt 
kidlridual, the fannion of tcs, the Tuioai fontti of loluittiaG^ Ihe dcrdopnot 
of Dind and body in the human bcini;, ai w«II u the proUau of liaality mt 
rrohitlon which ariie in retaifon m ducaM. alcohol. en11ii»tion, and edMUtat. 
Ctest ctr« it taken to tnture lacidity. Tbete b noch origEaal nattec. 

INFECTION. By Siws Woodhkad, M.D., F.R.S.E., etc, 
P ro fc wor of Pwluriogy in the Univemty of Cambridge. Demy Svtx 

IMPERIAL HYGIENE. By W. J. SmrsoN, M.D., 
ProfcHMT of Hygicno in Kiog'a CoUccc, Loaded. Demy Sro. [/n j 



MSTHUBN & CO, LONDON. 




1 


^^^^^^^^^^^^^^^^^^^^^^^^^^^Hl^^^^V^^l^^^^^^^^r 


■ 




A SELECTION OF BOOKS 


1 




PUBLISHED BY METHUEN 


I 




AND COMPANY LIMITED 


1 




36 ESSEX STREET 


M 




LONDON W.C 


1 




CONTENTS 


I 




maa tAom 


H 




titfi*m LliMSRiM . ; . ' 


URIa Uknry ; . ■ , m 


^1 




Aackm ClilH. ... IS 


Ltttic Qnaila SbtkcafEtTe . ■■ 


^1 




Antlguuy't Bwtka. 15 


Itlnuluic Ltbrarjr h 


^1 




Ardtn Shakrapiara • ij 


H(W UbCBi7 s[ MedlciBa . ai 


^1 




ClMtlca «f Art . . . 16 


New Ubrmry ol Uaals ti 


^1 




"CompMa" Stria •• 


Oxford filocrftpTilac tf 


^1 




rnnnrim nr'i Ubnty . rt 


SonuBilc Hillary ■ n 


^1 




Hudboeka of Bosllsb Cbutek 


Kuulh»k> si Thcolocy . » 


^1 






WtaliBiiiHct CaoiMaalailM t) 


^1 




lllutntwl Psckel Ltbnry oT 




^1 




Plain sad Colaund Book* ij 




^1 




iMitn •/ R>itc>» ■■ 


' 


^1 




Librmry of DcvMlott . , 18 




^1 




Uttia BDoka •■ An . . If 


B«akB (or 8«ra asd Olila . >• 


^1 




Util* OalMiM ... 14 


rtvnli of AlcnMn Oii«u i« 


^1 




Uttia Q^lM .... la 1 MatftOM** HiVBMr ■••^ « 


^H 




FEBRUARY 1911 


^^H 


1 


■ 


J 




A SELECTION OP 

MESSRS. METHUEN'S 

PUBLICATIONS 



tm Ibh rmlimi A* Mte h aecarfini t« nilfcKi. Aa uecrti* tfoaMi 
(tat lb* Iwdk <■ Id th* pMM 

Colmi*] XdlilaM •#• ^bSib^ vr all Us«. Mwrnva't Nenb Imbb^ 
M ■ B'inalwiv H. U. asd moiiIu tdllivni mn iniUkhM «f ia« n worts nl 

C«]«nU» and InitU. 

All Ix^ki mnilud Ml an Ml Mtlfxt IB <ll«BUt. M< MMM b* ba-<lM 
*t l<» thin iti* puWMMd pric* Bwiki kK Bukttl Mt u* aibju M llM 
diirouni ■hirh lUc brokidltj allDvi. 

ttnm. UtrnvKift bwki u« kcfit In woji ^7 >& fo«d hov1iHJlw«> If 
ten )• ujdimcuItT in mini af^H. Mmrv U<iIi>m« wOI k* vcfj |^ to 
kai* auly MlBimauii&. and (ptfiwa tPpi n W inj bnriu will W MM «■ 
H«*l(« a< >>>• publutiRl piiea ^/m peat>(c for bm to ah, and gl tb* ^U*haJ 
■ric* Tor ptJiztArj LruL l 

ihiU CsiLir.Euc (DRtiiM aniT • kImiIw cf th* Mtr* bapatnat taeta 
paUlihcd hf tiran MMbuiK. A MaiBkw tad OluMaMd cuilacut of Ifadf 
publicaiicM atj b< otilaiMd <m ifptkaUca, 



AUMiui* tr«c«)r). snt nnuT 

SJDNRY. UhMoiMd. SittmJ gdttim. 
F.X U-A- S«* BmMB 



-If.). 



AdT (CMUte ■.)- 
lIlLAN UNDER TtlE SroRZA. 



HISTORY or 
tlbB- 



QUKiH or 

II, 



IMUf jM«t). T H « 
LBTTCK WRITKKS. MuWItra 
SIvicnA. t)AH( sa Hon a 11 1.1, T, i6i&^ 
niuKnMd. .tAoi/ SJiiit*. Ptity »M. 
■ a(. Si; WIL 

Allm iM.V A msTORV Of YESOMA. 

llliMtaMl. JVm^Im. im. U Ml. 

Aad«r« (LMt). a skktch or 

KOriTIAH JIISTOIIV fKOM T«K 
EARUK^St TtMCJi TO TIIK PHK' 
SENT I>AV. Illowiutd. A Nrm wm4 
Cli*Af4' Ih^ Ormj Ih ft. U. lui. 

Andnww lAmt OJ the story or 

UAVAKU. MiHd Wj A. O. AmhUshl 

AndrawM vBUtMVL ppKcas. rut. 

VaTAE. Ti.nib'fd aiHl >41uit, witk 
Kmw, Irr r. K. BtKwrMMI, M.A^ si 
rm»r H«Mw OitML Cr Hk fc 



I 



no 



aun. THK TisrHiMvrmB 

BI.BMS BOOK. Praw MmI Vera. 

riM &<3ii rv s^tv^day 

vfKICXA'NDHE8TRtASUHB3. Chv 
Inwd. Kn»d cfmm. Km^. Im. |t- «( 

ArtsUtla. TMK rruics or. M»a< 

vlik aa latraduntaa anl Maa^ hv tas 
BmxvT.KJL CA«M- larariiSvkr 

Alkfiuan iC, t.X Kjl, ralw* a< E*« 
dalM CaBata. A HISTOSV 6r Oil- 

HAMV.iFMm»-ii<v riMiiam om^ 

AtklRtM IT. p.). KNOUS8 AKCHl 
ttClUKK. Ub«B»n4. M^laK h (^ 

A OLOSSARV or TERMS DSED IX 
KitOLlSlI ARCHtTEcnrKK. qi^ 



AU«rMg* 

Bfioffll 



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lUonnia^ 



A««a (Braant. 
dlsIrv. Cr. 1 



CO-OPEKATIVE 

BAcot iniahKrd). Tits ijk.KEa 

NURTUERN IIALV. ~~ 

lot. tcwi: 



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General Literatdri 



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Bain CR. HUbMV TIIK LAST RINO 
or POLAND AitD HIS CO»T£U- 
PORAKJES. UhHMWd. £m>9 ■«» 
M>. U. mil. 

Balfour (Cr»hwn). TBE UPT OF 

KOBKRt LOUIS STEVENSON. Wm- 
Cm lt«. ffmttr^m. t4- 

Sarins ^Th* Hon. ItourtM). A YEAR 

lit KL'MIJl Jn-M^^yiru^ Dtmy%»f. 

■Of. h/. fHt. 

RUSSIAN ESSAYS AND STORIES 
Stirm^ BMIim. Cr. hr. y. ikI. 

LANDMARKS IN RUSSIAN UTE- 
KATURK- C>. Ih. tr. v<. 

BaFtnjt-Sfluld (S.> THI Lin Or 

NArOLKOtf aONAPAKTX. IQaMtlid. 

tUK TRACSDV or TUK CMSARS: 
A SntCT or tub CHjuitmo or tub 
C^»]UH or ma ixiuAM aid CLjiumm 
ftcrctu. lllaitntcd. Srw»lk Editit^ 
Krr-t! let. lOi. M. ml. 

A IsiiOK OF f AIRV TALKS. Vlaont*). 
Sff*md £V*i'«#ii. c>. trr- ^*i:4*4f«. Cr. 
AIM Mt4-M-i Iw. M. 

0U> KNCl-lSIt FAIRV TAXES. \X\m- 
nM. Jiurd Sditiam. Cr. hw. <W;k 

rue'ViCAR OF morw(.mstow, rc 

TiHd EdRisn. WUh ■ r«inii. rUr.^ 
EiliHn. Cr. tnr. y M 

OLD tX>UNTRr LiriL llliuIKIEd. /'t/'JI 
KA'Um. L»rt» Cr, Ih. (4. 

A CARLAKD OF COUNTRY SONG: 
Eniltth taOL Sonft villi ihcif Tndlckniil 
Hclodles. Colltcitd ud MniiRd tiy S. 
Suiiii«<!ocui wnd II. r. SnrrAis. 
/>•••/ iM. Ar. 

S0M(£1 or THE WEST) Pslk Smn <>/ 
Dnak U)J Catmd. C«llc<Md fran tli* 
tUuEktafllM PMfh. B)pS.HAMMa-GouLL., 
ILA., m4 U. ri.>«r<inx>a SH«r*«>fi, M. A. 
Mtw kod lUited Ediiloa, andc* (be aiMical 
4di<qnh)r ef Cacifc J- SHAnr. ttifr /«•- 

ST RA VGK SOBVIVALS ! SoMI CMirrw 

IH THI Miimv or M». I)liflIn(t<L 

ri^^ £.<uw*. C>. Irr. w. U. »«. 
rORKSRlEE OPDlTiES^ tuOMMTl 

ABi> srmuieR Kva.irt. F^Vt £Stitm, 

Cr; (M ML Ml wt; 
A BOOK or CORKWAU, tVuMMd. 

Strm^Sdfliim. Cr. 1m. «>. 
A BOOK OP DARTUOOR. lUuflnud. 

StumdSdiiim. Cr.trr. ti. 
A BOOK or DEVON. tUoilnWA. rkir^ 

tUitit*. Cr.tm. ti. 
A IIOOK or KORTU WALES. HliB- 

A BOOK or SOUTH VaLBS. IUw 

A BOOK or BRITTANV. Itrntntti. 
SmmdMUHm. Cr.ft. U. 



A BOOK or rilR RIIIKKi rnn On* 
to Uiin. IU.w«f4. .fan-' £:<f(M 
Ck Iw. «(. 

A BOOK or THE RIVIERA. lUiu 

Dilnl. Stand IHiUm. Cr. tm. ti. 
A BOOK OP THE P^'ilXNEBS. IBv 

I»(Hi. Cr. Itv. b. 

Barker <B.\ UA-.CLauiriikworMEiiM 
Coil«^ OifHd. THE rOiJTICAl 
THOllCHT or PLATO AHli ARIi- 
IOILE. Dm^t^ it.Umtt. 

Baron <K.B.K,XUJ^ FRSNCItPROSB 
co«K)srn6N. /-«r«4 xji«™. cr. 

•cv. sb 6JL A'^, )i. »«. 

lUtlUlOIMW (J. O.). r.R.9.B. St 
Robcnwi (C C). 

Baaubia <C. F.}, LUD. THR COM 
MERCK ^fSATtONS. fvwi* KdXtir* 

Cr. Jw. K. &^ 

THf. tvoLuncJy or Life. iiiu. 

iicmL Otm/trt. jt.td.mtl. 



•atson inn. SUc 

HAKDIIOOK Ori 



I. A coirctss 

□EH r LOWERS. 



ThT SUlfMER^'GAROEIir Or 
PLKASUHE. lUtMnMd. M'iA Dn.. 

BactcMt (Arlborjb THE stirIT or 

THE DOWlfS-. LnpcaUecH u4 Rini- 
nitmica oflha S<i»« Uemn. llkunMciL 

BMkfOpd (PMar). TB0UCHT5 ON 

UUNTINC. KillMd kf J. Orm> Pj.cn. 
llhiilfMfi. SKimd JUitM*. Ormj ti*. Oi. 

BaEblo^HaraliJX MASTER workers. 

Uputuui<I. Dimj tor. }i. V. ntt. 

Bahmon iJaeobk DIALOCUISONTHE 
!;1;FI.KSENSCAL UFB. Eibol W 
Eiis-uiD HoLUivit. /V^Z-Bmi V-^i. 

Boll (Mpi, Artluir 6A TUB SKIRR 
Of THE GREAT CITY. "rMlrwit 
.9«»wf e^ifM^. Cr. fc*, tr. 

BMIOt (BA MP. PABI5. DluMial^ 
Srttitd J-dittw. Xniint. <r. Sm. it. 

mUJ3 ANI' THB SEA. TAird KiUUm. 
fn*.*r*. y. 

ON NOTIIlSO AND KINDRED SUB- 
JECIS- ni-^ Ii4ilitm. Fkm/. Int. u 

o» vn.mymKC srt—dsiiim. fJf. 

HARI%' AKTOIHErnL HloflnHd. 

nunl Edilim. OrmjtMi. ta.ittt. 
THE PYRENEES. lIluKiaHd. Smmd 

X^titm. Hn^ tr* 71. 6d ttt. 

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Bsnnott tJoMpkl. rOKTV vEUts or 

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Btnneit (W. m.i. u.jl a primes or 
IHX BIBLS. #VU A«Nm. C>-- Sm. 

keniiMI(ir,B,)u>iAd«n»y.(W-F.). A 
tanaw HibrMcnvNf ■ PtM MJHit^. Cr. 

BeHMB (JtrctaUilMpl OOD'S BOARD. 

VmiMB (K. Na THIt WAV or UOU- 
SESS, An Eipotiiion td rwln oda. 
Aailrlicsl uiJ Dtn*nnkt. Cr. •«*. »■. 

■SeisuaMi (SniDiKl UV KOUE UrE 
IN SIAlii. Ululiaivd. I><«r IM. 

B«rpv (W. GPlntooX H.A FRancx 

BEtJiun>Ed»u4i M\*t\. (ICU(R UPS 
t» rRA.VCK. lUolInUil. Fi/t* SOMit. 
Cr. Im. Gf. 

■l»dl«lT. 8«Kb«rtX M). THROXOT- 
U^ilCAL DOCVMENTS OF THE 
rAITH. vnik lBU^ucik>M ux3 N«iM. 
SKmid eMtim. Cr. Riw. «(. HI. 

Blnroo iUur«il«eX Sm niil< rWiUluil. 

BlakB Wiiliunx illustrations or 
Tlli HOOK 0> JDFi. With Gtaeril W 

trDdnbtioa by [^liih^s Bektdiv, IJlu*- 
mtsd. C^ftt. If. mif. 

Bodr (Ccepse), D.D. THK SOUL'S 
FIUiKIllAUK: I>ci«<li)iuIKc>iliii(ilV«a 

Gtatt* Btdj, D.D, S^ititti tad wi>i>ii<] 
by t. H. B^u. D t>.. F.R.:i.K. IXrmr 

BaoninC(W.)- TASSO AMDHISTlKKa 

Bairtp (W. B. ronWM. HUSOARV 
AND THB HUN'MRIANS. IIh»u^*i«I. 
0»V liv. }i. 6^ iv(. 

B«waMl':B.VA THE IMirATlOH OH 
B U D U It A ; Bilnc QaoladmiB fcDin 
BnMblu LucruuK hi uch l>>7 Id ibc 
y«u. >v'r't ^diiit*- Cr. itau. H. W. 

Biwtant tr. ex K.A. K.\MBl.Bg IN 
SU98KX. niDUWDA. Cr. (ML e>. 

Bi^IbtCA.OA rovndaboltwilt- 
StllRK. Ulu.ti.1*! SKr-J fJili,*. C' 

THK ROUAWCB or KORTHL'MltBR- 
LAhD. Ilhuuiu4. Sttnd^Aiun. i>nv 
tm. fcU-aM, 



Braid (JiBMr uid OtIvoM, GBJtAl 
t.:oi.FEiCS IN IKE MAKING MM 
%y IUkkt lAtia. IlluiUatid EMM 
AiA'hMt. i>r«v**v- f/. Mi rwt. 

enJUIlM^ IB. H.t UACKDONUi In 

Ormjtff. til 0><L ■//. 

•Ml. A COSCISK DiirnoSlRv& 
SCVn'UH ARCHiCOLOGV. A Km* 
kack Im Siid«Dit wd iiivcliaa. Uw 
•i*Md. Cr. Ipw^ t*.td- 

BwWBfJ. Wj»dtM.A, THR BUlLOnU 

BrawnliiC iRobtMl- rARACSL5VS 

(n^rtj tliiMiuir I. t^a m4 ICaiiu< 
■mi K. LacocK. AV- *■*- >i. U w<. 

tutliioa '>. ■?. lAGKK HKART; A 



Su«n «. A. w«im3, 

'fUE EGVlllANS. Ulmt«M« 



TKKGO0S4B 

Ulmt«M« fta 



Bull (PmII. A»t<^WU«- COD - 

Bull«r<VlHl. Sh ODk* CLmIt*. 

Sums <R0t»rt\T1IE POEMS, u 
AxpHiw Lam hM W. a. CkAtMC -■■ 

^/ Irf. tt. ' 

Bu«(en (F.W.X DJ>. CHRISTI 

lllKOtXXiyAMDSOaAL PBOUI 
(Th* fUnnco* LCEMTH u4 ifoj), 

''S.'?AETI'2M'^rH&i5Bfr 

with •«• oiUi W*,iU, TWwJMi, |M> 
.fa*. Cr. (H *• wX - ■ ^ 

ButllB (F. H.). AMON'O THK DANBl 
liiuiiiiKd. Draif iM. r*. U «/- 

Munaw Kii*. WALKS IN 
TraftAuJ br A. R. ALtt-b-. _^ 
UuMntad. wmf !«« r*. U mit. 

CMa«*«n<1t«irrLovMi^OLDeTSURiA 

ANDUODEkN IUKCaNY. rh.HM«i 



rARK. 



OEHOA. UtaK 



Wl. 



THI OTV or 



General Liter atvkb 



FM-IJI* (TbonlM) THH rRKMCH 
RKVOLWTION. Hdfurf by C R- U 
fLrrciiK*. I'allnr t,t Mw^iIch Collitt, 
Otlorj. Tirrt fttr—JI. Cr. Si«. lij, 

THE LriTEFS AND SPEF£:HES OF 
OUVEK CXOMWF.I.I.. Wlih h la- 
trodnetiin 'bf C 11- fitrii. H.A., uJ 
NMrtaixl A)>|i*iuil<«i Iti MivS.C Loa.u. 

Celano iBi-cch»F Thcimu of). TIIK 
UVK6 OK FRANtJIS Of AS31SI. 
TMMUlwt by A. (r. FiurEU Ojiiitii- 
llluimwd. Cr. («> V "'• 

CIUtinb«M (Mpf. LvnlMFtl. L&wa Tentfa 
fn Lidltt, OIuMimitiL Crrmt Iw. •>. W 

ChAndlar inrthtirl, Biih»po(Hi>««fc«ii«in 

AXA CUXt; All EsiiT m HmiMi 

TiiSiiLAor. Foitrtk £ditifi%- Cr. 1*^. 
y W. iHt. 

Cherterfleia Xopdl. TIIK LETTERS OF 
THK i-XM. OK CIIKSTEKFIELO TO 
HISSUK. £iliH4, •ntbulnir«]Bnl«t>3 
C Stkcksi, viih ?i«« by A.C«i.TiiKar. 
r^M Wiimma. Cr, tut. lu. 

Cll«WPton(O.K).CHARLESI>ICKK[(S- 
Wilk tro Paniiiu in Pliutiigavim. Sitti 
KiilifK. Cr. trr. (u. 

*LL THINGS COKfiir>l£Ri:I> SUU 

TSKMRKDOUS T KIFLZS. fmtrlX 
JC<IJft.>a. /;&■/. iMl. it. 

CUDs«a iGeoFnt, A KA.. &.W.3. SDC 
LkCTUKRSONPAlNTIS'a lUuunud. 
THn/ Si*M«i. Lfr'Ftit. Siw. y.W.m*. 

AtUS A.ND lUtAUS IN AKT. fei»hl 
LcrtsiH dtli^TTcJ le Um Snidfou el Ue 
Rtyal Audtmr*^ Ain. Itlaiintel. SitrmJ 
JlAlirm. I^rft frtlte^. y. art 

ami«n-Bro«lt (A.) SUgu-EY : THE 
Man ANU 1M& rOET. lUuMTMcA 

COM (W. V.y U A- THE BOOK OF 
rSALHS I widi ao lolmluclk* ud Koiw. 

C^Md. TDK flLGBJM FAtHEHS, 
niiB Cwmtn *i>u Couun. IUumimL 

Cettlnrwodd (W. C.\ Mjl THE Liri 

Q( JUIIN KUSKIM, Wrih PotiniL 
J^' I rX^ K^inint. Cr. In. u, W. •ul. 

C«lvlll (H«iM K.X ST. TKRESA OF 
SPAIN. lllawmtd. SmmU g^A'tim. 
Drmr tot, ji. U. mt. 

■Condiimlna (Rotort da ImV THE 
Ult'H k. QASritlN. fctf.tf. v.mn. 

Conrad U08spfe> THK MIRROR OF 
THE SKA: Ucofna tBd InaoiuaM 



Co<)l!4ff«<W. A. B,k MA. THE ALPS, 

Coo(Mr(C.S.1.F.lt.H.a 3MWM«ll(W.r) 

Coultoo ^6. GA CHAI7CRR AND HIS 
FS'r.IA>fI>, iDoiKnK^ SnraJ BJilitm. 
Drmftt*. .tj.U.mfl. 

C<nrv«r CmiUnmi- THE 



C. ButisY, M.A. 
n>. &/. iv<. 



rOEHS. 

lIl4inu«L Owv 



CnuM iWaltflr), R.w.s. AN ARirarS 

KKUIMISCKNCES. II) t*. Sttrmi 

£Jtltta. Dtmt *er. Uj. mtU 

INDU lUPRESSIOKS. tR<MiM*4 

CrUM'T. t.). RRMtNISCENCKSOFA 

l>rmf trr tet. tj. wt. 

Crawler (lUlph KJw TtlE HTOIENK 

tec. y. 6d i^Jt- 

Danu (AliRbiori)- la coumkdia di 
DAN IK. Tta* toIUB Tcu •Otti bt 
l-Ar.ciTsrMMmXI.A.. D.Un. Cr.lrm. «*. 

l>av«vERlcbnrd>. THE PACKanjt OF 
Dtmf Im. If. iMf- 

I>»»l» (B. W. C,X M.A.. rdt>» Bri ToKB 
o( B=irMl C?ltic» ENGLAND VNOER 
THE NORMANS ANl> ANGf.VIMS: 
wflt-irfi. lUuittkUd. ZV>a>tM. ivi.U 

CmdI (R. StOrrrV THK THIAU OP 
FU'RQUEENS! R^TK.iiKiapAkAAaK, 
AUK* BouiH. Mahy IJi.'iaM or Scsn, 
U*1IB AKioiHVT-n B&i Caiodhb of 
BavinwicK- IlloitnMd y*mrf Btilim. 
Oimj Hv. tM. Wl «(. 

DMinner (H>.bel>. A CHIUVS LIFE 
OV CtlRI&T. IDMlmai. L^rit Cr. 
If*. U. 

in«U'»u-Aral). IN TBB CANARIES 
Wim AcIUKRA. lUutnuJ. C'.Ihl 

DMUDVOO (0. I-\ M.A^ FcDa* of Klnt-t 
Collns. U^MbrMc*. TIIE ORRKtC 
VIEW OP LIFE. St^mik ^md Xtrint 
SJUin. Crrtm ••*. h. U wf. 

OrtehSeM T. B.'. M.A., r.S,A. THE 

FARI^II CUEKK. lUounnd. Ttird 

TITB OI-ailMB PARSON. IDiiMrtttd. 
fMM^ CiKlka*. Dm/ tt*. jt. U mA 

D»afflt»mngh».\. TKKICSONFOOT. 



W^b tb< liamr* s( Ibi Good OhI. 



IBiutnlad 



Metiiubn and Company Limited 



DOUSIU liunUi THE UAH IK THE 

riTi j-iT. (.>. (M, w M mir. 

DOWdan (J.). D.n. Lm* Lord lUAsp ol 
t-iloV..;.).. FURTHER STUDIES IK 
TUEPRAyBK HOOK. fr. (». U. 

Orlnr (S. B.1, CO.. X>.CL,, Kcdm Fn* 
fcHOf (C tlcbnw ui ibt UflimMiT «< 
Oifstd. SKftUONS ON SVUJKCTS 
CONNKCTKD WtTM T1(S OLD 
TBSTAMXKT. Cr. •». ti. 

DoIT i»om. MATILDA OF TUSCASy. 
lUuiitusd D/my ttt. »(. 6^ mrl, 

DuRini lAI*xiin>dra1. THK CRIMES OF 
THK KI)H(;1AS AND 07HIIRS. Wiih 
M IniiDilu^SM by IL S. CjU>stt. 
Illu'lIjUtl. Cr. trr. U 

TKE CKIMES or URRAIN CRAH- 
DtUR AKD OTUSRS. tUunud. Cr. 
hw. U 

THR CRIMRS OF TUB UARQUIBE 
OK ilKtmiLMICRS AND OTil&KS. 

IllntlfU^ Cr. tcii Ol. 
THl^ CRiMKS OF ALl FArllA AND 

OTHRRS Itlizicntxl. Cr. ■■«, u, 
MY HBMCIIR5 TnntlMcd (7 R. M. 

Waumk. Wlik u [MnsliMiisB br A>Bii« 

L«1M With FiMOip ln w k Pb<c<tn>*u<«. 

te ib-ValanM. C>. IM. hMfiMfaw. 

Vov. I. llr»-)l«t. VOC ir. lt»-t*tL 

Vol II. ilH-iJ.j, Tm. V. tati-iBn 

Vdu III it>o-ii*L Vok VI. Mw-iln 
Ur fSrs. NtwlT n<n>*>«l bf A. R. 

AtuHMK M.A. tUumud, Cr. ••» f. 

(taBe»D(D*fM),D.Sc.. 1x0. TKEurx 
AXD LXIl^ltS OF HCRBKHT 
Sr&NCIR. tUuMtf^ Cm7*l». iV- 

OuDD-PBtUMD m. P.]. NArOLRON'S 
MARSHALS. IllMTUcd. ntm^ —». 
Ste—td KJdlia^ IM. td. mlL 

THt BtACK PRtKCK. tUMi»i.i. 
SumJMMit*. Itm^lM. ti.tJ.ifl. 

Durham Tbn Karl an. A RXrOKT OH 

CaNaXi.i. WUli *s lamductHT N«M. 
On*/ Ih. fi. <^. Bf/. 

DuttlW.A.}. Tint NORFOLK BROADS. 

Illuumad. iM-^md tMtim Cr. (aw. )» 
WILD UTB IN CAST A.NOUV OIm- 

triMd. SttrndSdUim. t>tw^*rf. T.td. 

(OMH LITSRART ASSOaATIOKS Of 
RAST ASQUA. DloMnuA. D<^,*m. 

■tfM BB rfj (laJOF J. B.I, R.R.t D. A. 
li-U. O. hot Woat (W. Jiak\>Bck?. 

UwnrriM Tkknar!. TtIR LORK OF 

XHlt UOHIV UUL Uloaniad. Cr. 

urt-Lk-cc OM sovrauiN roads. 



ifMMD iTi XI. M-A. A HtrroKT 0*1 

TlHJ rl5li Q)1>)MUL fOUOf. 
tduttm. Utmj IM. fa. t^ bM. 

B««Pott-Crean_(IIAPT Aaitaf. RIWH- 
DSTIIl KLXCTRKS-^ P TTArtNC AJO) 
QURCa OF BOIIRUIA- ILi.iM4 W 

Mom bT A. W. Wauh Un.D. Xh^tai. 
lot. M w/. 

ralrbrBthw tW. H.1. U-A TH8 PHTIO. 

SOPUV, or T. H. GRKCX. Stt*U 
SdlHm. Cr.trr. i>. «^ 

Ft* m\uA THs rucRT or tbi 

edMrm. Drmf trr. ji. iM: mtt 
SIJCRBT CHaUBBRS AND HlDtMP- 

rULCXS. IDut»l*J- Kn mmi ' 

Uitim. OtwHtlr*. ii.t^mt. 
JAHKS II. A-tO HIS Wives. 

Dtmjtt*. ni-Mmf. 

FM IB P. %.\ niB FOVKDAnOn 
orLlBBRTV^ C>. Iw. «. wA 



M«I«a HliTTT » OiKard. CROU- 
WKl.L-S ARMY: A BiMoy afite EmM 

■ - I - ~ ^— ■ - 

nuCermld CXdtnrd^ TUX XURAiriT 

OF OMAR KHAWaM. rnftmt tttm 
lb* FiFib Md lul UitiM. VM ■ Csa- 
■KHUrr bir Mu. ituriam Batw*. ni ■ 
Skimpbr «( Obw ^ B. Sl. R0M. C. 



'FMobap «, J, Bnl ■. 
KKULISll UoilK. lUi 



Am/ tiw. iw. UL M<. 



TUB 



BOOK or VORl- 



SHUUL 



FIWCfA W.) M.A-. W.ti:.a D» 
•C Psiiilol EcBwBT =. M-Cai UalMwr. 
Ueeoul- ECOSOMIC nUMOPUi 

Foot tCoBiUDM H.l- tKSXCT WOX- 
OKKLANU. RbuUMoA StnmJMJiiiiK 
Cr.tm, y. Uw«. 

rorvi (A-)- Tiu sxNSBS or titsscn. 

. .U HetUl. SIHTKAH AXD 

tJUMPA.MOHS. ''• '-ri tn A. 

C F*>«.-iiAOeii. IHaDUBd. fWrfc* 



F^Jg- 



pruer u. tA KOimo the 

ON A wSefiu. 

Sditiit. Cr.»K (» 



rOKLD 



GBHEItAL LTTRRATURB 



aiJUm (Sir PruiaU. V.R.S.1 D.C-L.. 

Oif.i Han & U., Cso^i Hn. Filfeir 
Trlnil* CdllM*. Uamtiridee UKHOKIES 
OfUYLlrft. Illuurxi^ TiiirdEMim. 

Carnan [Luey ■- JJ. THE TtlRKISU 
PKOPLfa ^ Tuiti Social Lin. Kauciout 
BniinAHu UiTituTinHt. ami DouMTK 
Urs. UliUlnt^ Dtmj Itn^ iM. 6A 

fllbbln* IH. At BJ. LiltD., MA. IN- 
DI'STRV in KMOIJIND! HliSTORI- 
CAI. OUTUftK& VrUh > Hipk Ff/lA 

TKK INDUSTRIAL HISTORY OF 
E N G L A ^ D. IlIuiliHeil. iii'ftmiA 

ENGLISH SCKlAL REFORMKRS. 
Sk0U EdstifH. Cr trt. ti.U. 
Sei>U<>Hi^f.tI<], ItA. 

GlbtMn (Bdward)- MKMOIRS OP THS 
LIfX or KDWARD OmBON. BAiuA 
W a. Biuikti Hill LUD. Tr. ttv. A(. 

•TBe UKCLINfi AMD FALt. OF THE 
ROHAN KMPtXK. lUii-d, ■bb MsM, 
Appntdlcn, and kUio. br J- B. livir, 
M-A., LtCI.D^ lt«(liu rretaHH el Mvtea 

XikJ iu. fj. Hf. 

Gtbbl iPMIIa^ THS XOUAN'CK OF 
OMJKliK PlLI.lf.RS: FIRST ]>UKS 
OF l<LCkI!4GHAM, AKD 50MB KEN 
AND WOMEN or THK STUART 
COURT. UluilrMed. Snm/ XdMm. 

010*1 m. R.1 Mid WyiiH CKau N.). a 

IJOOK or tMULISlI •^ARBKNS- 

lllu.iiKitd ffrjtrr. iai.6d.Kn. 

aiovor (T. R.I. U.A., F<l1o< vd Cl-u:^ 

Lnluiti of SI. J^bft'l CoUiM. ClmlnUe*. 
THE COSftrCT OF KFI.lGIOtiS FN 
THh: E.\RLV ROUAN ll-MPiRK. 
Jfm-U £AnHL £in>7 tf. ji. W "w* 

Cpdrtnr (EtlnOMUil. A ROOK or RE. 

for ••(■T dir ■■ I)'*' V'a'. Arnni^d hj 

M. td. mil. 
ENl^USHCHIIttKRN IN TKF. OI.DRK 

I'lME. Illmaud. SmtiEditHH. Dt~g 

C«41«rUL. 0.1. M.A., r-lln* of Mudthn 

caiiMi, oir-vd. oxroRD m nm 

KtGllTXKirrHCKNTURr. lUuiEiiKd. 
Strr^J Kdiii0*. Otmrtv*. ft. r^- v(. 
LVRA nUVOLA AmrTA xJili^ fc*f 

VRRSR8 TO OBDKR. J'wM.rf tJiHti, 

ft^. IM. ■(. 6/. 

gECOHD ITitIHGS. A«^. »w. w. U 



floll lAulutt). CRIMINAL TVPKS IN 
liHAK.&PKARE. AtuiH>iMd tnonli. 
tickti (ms lb« UniUb br Un. CiiULM 

Cordon (Una DufT IVr>. AubnT Vu*r- 
%t\&\. HUUK LltElN' llALV^Ln-nOi 
rum TKK AriHKiiu. I.IuituidJ. Simi 
Edilim. Dfj tMk ■«. AA mtT. 

CMttln«IFranc»iM.I T118 BRKTONS 

ATH5MK lUutiniid. 5mnd Editiam. 
Otmj tvf. IM. ML KM. 

Gt*»iaa iMaPpr). A GROUP OF SCOT- 
Tl.SH WOMEN IlluitnUd. Jnn/ 

OmhAiB* iKonnath). thk wind in 
lUK WlLuJvrs. illnualMl. fi/li 
Hdiliim. Cr. Sm. If. 

Gwvnn [StoDhftnl, MP- A HOLIDAY 

IK COXNKMARA. llluttntfd. Dimf 
hn (M 6^ on. 
HlUl (Cyril). THK VOUNC CARPRN. 
TEK. llluimied. C>. *WL j». 

Uall IHammond). Tim VOUNC. KN- 
ClKtJCk ; or Nf [:^r>a*K Ejvuikftta awi tiaaEa 
MouBLl, IlluUaisl. SnmJ Editum. 
Cr. t*>. it- 

HaUtHorr]. AWOUAN'STKBKPROU 
THK CAPK TO CAIRO. lUawnnd. 
Sm^iU Edirit^ Drmf Iw. lAi. aif. 

■ucittl rPranlC FAMOUS FRENCH 
SaLOMs. lllBtnbd. r<4»ntf EditiM, 

BuinAy CD.1. A SHORT Hi^ORF or 

TUKKOtAL NAVy. Vul. t, i»r >»«. 
VaL II., (Ua-iIiv i><j>tr tw- '•<* 

lUuMlftr (JaCDM 0,1, M.A. THK SPIRIT 
ANP OKKilN OP CHKlVriAM 
MO.S-ASlICISitf. C'. tH. b. 

THH WISDOM or THK U&SURT. A>^ 

Uarper ICI>«fIm G.). THK AUTOCAR 
kOaD-DOOK. l'«iirVvlnin«>ia, Uafa 

V«iL L — 5eoTB OF tmi Tbuix- 

VoL II.— Noinii AND South Walu 

AHO WkH UlOUHOfc 

Bwdlar [?. W.J. DARWINISM AMD 

Cr. IM. it. lUL 

HandaPMn IB. W.). P*tiav <>r K>Mrt, 
C<i!kta, OifarA THE LIKE ANT) 
PKINCIPAI'E or THE KMl'EROR 
NKRa UliutnMd. Hi* md iJlmM 
aim. Omtr St*, (i. id. mt. 

Handonofi CS< Slurn). CBOROC 
MKRRDITfl I NOVELIST. POET. 
KKrORUER. tUiutrUcd. Sif*UUtli*u. 
Cr. »«. U. 




8 



Mbthuen and Company Liuitex) 



■Muhrvoa [T. P.l t>« Wntt nFr^neM. 
SSnl-Atlb oi TO-OAV. tlu^ncS 

Renter :W. 1.1 KNGLISB LVItlCS. 
LHAVCIIR TO f*)t, iua-it4). ^Mitf 

£^1W«. Cr. ■«*. M. M WL 

HmvieU IWJ. A HISTORV Of PI- 
RUOU. ItluUHd. Onv***- iir.M 

UASTEffpTCCtS OF SCULPTURt 
Uluutdtd. £t(«qr Ina. n>. M, ih< 

Hind iC Uwls) DAVB IM CORNWALL. 
lITuarittd. St*^ HJitifn. Cr.trr, tl. 

H«biio«M nu T.h lua r*ui» If CQC, 

Ocl«d. THK TBBORV Or KX<7W- 
IBIKM. Dt^v »-*■ i«t.U.mH. 

Ho4fMU IB- A- BravlBTl- TItS COURT 
or RUSSIA IN fllK NIMtTXKtiTH 
i^CNTURV. t!l««i«»A 7w (HtuM. 

HodjnoniHr* W.i now to IDKNXTnf 
OU> CtllNil.'vK rORCKIAIN. Ilat- 
nsMd. Sk*<U tUitit*. Pi! Im. b. 

HoldWKSIrT HV K.C.l.R C-B^ rj.A. 
THK IMilAN- ^ORXtlUtLAND. lOo- 
wo. IlliwmtJ. StamiUiti^ Drmj 
Im. i«i,U: KflL 

lloldiiirarUi(W.S1.n.CU A IIISTOBT 
■>r KHCIJSH LAW. /■ Aw Vttwt. 

wf. 

llollM»d (CtlT«|. TYROL AND tTS 
F-r.OPI.E lUydnitd. £>«v(h^ >hU 

•tit. 

Hullmr C'lihrop tl C). tau it Hkltu 
Cnlleii. > It': '. -, buar c4 BiH CofiiM. 
rKT^AKUI: llU: UIE. WURK.ANU 
TIUKS. DIuMUd DimrU* •*(. UL 
<vA 

BoPibtlMtl (B L S), MA. KIRIUIZO 
riUl NAGNlnCXNT: AKU FuaaHCi 
in MB! GoL«iB Ac« JUosuand. Sicmd 
iJirim, Pm/ tr*. tu. jarr. 

WATKIUJ30;>iikPUa Sttmi SdMt^ 
C-. tr*. y. 

Holla CAlHAndM-;. MAKCHl'IUA. IDu- 
inMd. JWhU JtJMfm. Ott^ lev. r«. U 

HuJim :Siunu*i r.v tux clkrk or 

OXFORD IN rICTIOH. [Uuuaud. 

'HiuDDlmn JMbq. ai' PKOPOK- 

TIOMU. RWRxiiNXAnOM C.lm 

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ruxrsT. lilMrs*^ /«-^A Kditit» 

CV. iHk tL 

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Cr law li. 

TiiK ciTiBs or srAtK. 

nXikCMCK AND THK OmS _ 
Mi>HIIIKRN TUSCANV.WtTB 
GENOA. Uluas^ f.K«»/ - ~ - 

EMCUSH LOTS POEMS. 
» t>lrDdocrio& fai» IML u M art. 

C>ltl^-rKVWALK5ABOl;TrLOKU<Ct 

IllHDBMd. AlU. >■«. U. ««. 

I» UHKNOWM TUSCANY Wfek v 
A f p i aJ L i b|r Wituais IIiBT-ve*» [>:* 
micd. .C*r4>^ £iVftH. Omv Ih. m U 

ROUS, tllailnud. S«m/ irflTfj ■ & 
■Ml b 

arm (P. A.) plokkkcs : «■« ir.m« 

COD Ajrr t j tbs Fau. of tsb RsMmic 
Dtmij to* tl «al wC 

IbMIt iBanrfk). BRAND, a tiMak 
TnuliuJ ^ WiLuia Wkmk A»«i 



lAjn(W. BV HA, Fclm b4 T< 

HM 



J* I W. Hi. H.A. Fcim ■■« Ta^ « 
HiCi-d OiIW*. Oitbfd. CURIiTlAJt 
UVSTtaSU. ITV. RaWMi U>ci«n .« 

lDoes:A.DA U-A. AHlsrORTOr XIU 
tiUlllall In I.-<0IA. wuh Uats >^ 
pliiu. O. (» «(. 

BXGLAMO UNb&S TUS TVnOKS 
WIU Man*, nvtf ZAUbB. Omh te 

tM. M «v(. 

iBDSi lHarrl. SCI100t3 Or PAUrT> 

IMa tllBWiMd. Cr. %m. (K B^. 

Jtbb tCanllUU. A STAR or thi 
SALONS: Jfu* M LAiriBuaa. la^ 
B«H^ OcKV !•*■ •••. bd art. 

jsffDiT iiUffiniiid W.I, M.A. rnt 

HL^jfORV O* THK THIRTKKS 
COLONICS OF KOKTB AMKiUCA, 
iMf-t}«3. Dlownud dl^am fi-td 
mtt 

Jenks 8.1, U A. B.C.I- AM OLrnjia 

OF t.NuMSH LOCAL GOVEaXMlilT 
SxmJ tMum t»nmi hTR.CS. 
EMKK.U.A. Cr.ll* a. U 

Jcnr.ins> iO»«Ul. ^.D. BARLrWOOfr- 

ciri T.MtiALS. 
Jeralirstiun IChATlM SdVuA. THI 

MAXIMS or UARHADUUL Sttm* 

Johnium iSIr M. H.l, K-C B. mRITtSS 

(.I^IK^LAIKKA IiriMilil J-A*a 
tUiltK^ Cr. t*>^ lb. ■■(. 



General Literature 



THt MUGKO IN TUK NKW WORLD. 
IIJuiim«iL Dimt Sml ttii. tuL 

Jonas I R. Crompton), U A. rOBMS OF 
THE INNER T-irii, S.l«w4 W «. C 



1/. M. ■#/. 



jr^ Im. 



REVKU^ 



Jultui M^r? of Nopwleh. 

TIOMS or DtVlNE LOVE. Ediud by 
GmAO W«>fti«K. TXirJ Bii^tm. C'. 

'Kappa.' LEr voutk kut knowi 

BJititn. Cr. tv*. y. U iv/. 

iUati IJolinl. THK POEllS. 'Siiud 

vkti [r>ii9'Iuc(ti>a an J NdL'^i ^ E. dt 
Sdj-fuvii, M-A. WiUn fmnlupwcB in 
P^LOiu^rA'Uf*- Sff*wtJ Eitilitm Jifvfif^- 

KebtolJobD). TIUCCHRtSTtAHVlUR. 

Willi in InHeJui.tiLiB tod Nuta by W. 
l/XW, DO., WanlH of K(l.k CollctCL 
llluxrand. rlj'n/ edliitm. Ji*f. hw 

RmbvU rrtiomu a|. IHSIUITATION 
or CHKIsr W>it an Introductiaa by 
DiAH Faiu*. IllunrMtd. nM 

mvfft^t y. 

Alw Iniulaud ty C Buo^ D.O. Ck 
Im ,1. &^ 

Kerr (S, P«rncll), CCORGK ^iKI.WVM 

A.VO THK Wll'l^ llUnrkitd. £V*v 
liv. lu. biL sM. 

KlpUnit jlludyftFiti. 8AKIUCC'R00M 

n^ii:k L.i,iiiKi. Cr. In. ai. Atm A.^/. 

TH& 5BVEN SEAS. !■>/ rAfimxil 

SiMUnriA SJilini. Cr. Be*, tt. Aks 

/<^. ttw. i,r*l*tr. u. Mr. 

THK FIVR NATIOSS. A^f* TAwa-W: 

SntiUk EAlint. Cr.^*. Cr. AlM/'ai>. 

Im. Lntktr. ti, wr. 

OF-l-AKTURHtALDrrriBS. KitkutatK 

SJUfn. Cr. («». 6(. AlH V:^. Irv, 

KnoK (Wbilfr^ P.I. Till COURT OP 
A SAINT. IlluunUd. Ol~', b» 

LMDb ',CbartMWKlHaiT).TiiC WORKS. 

IMiMil bjr K. V. U'Ul. lllvitnltJ. /« 
Asm Knftona. iJnv *•#■ ff- U M«t. 

Lui»-Poota iStanler). A history OF 

KUYFT IN Tlllf MIDDLK AUSS. 
tlluimiad. Cr. Im. &r. 

LMlmMr Sir Rat], k.cb.. F.R.S. 

SaCNCS FKOM Ail BASV OIAIK. 
Ulmnwd. >V<i* Saitltm. Cr. It*, b. 



UaehiHoniv). THK SPIRIT 07 THE 
UNks. Cf.lM. U. 

U Bns UnAUl»l. THE LAND OF 
FARDONS. Tiudalsd hv Fxavcb U. 
GonuMO. lUiiMnud. ri»<^ Eauim. 

Cr. »*. «f . 

LoM rpredarkk^ a SUUMliK in 

TOURAIKK. liJMiiMd, StenUHMl,^ 
Ovj Bf» »i. bd. mi. 

UndsarlLMlylbilMl). ANKtDOUmi: 
A Gnuu. »TVI>T. MTltk Uapt. T^v 
CWwui. Suftr Mij*! !>■■ aw. lur. 

Llowcltyn COwon) *ad Aavm-HIU IL.' 
TIIKfOUTH-BOUNDCAIL lltu<>r><*J. 
Cr. Im. 4>. 

Look iWUtar). D.D.. Wud«n «f K.bU 
CuIIfS*- Sr. FAUU TIIK MASTEX- 
IIUIU)£IL n^r^ SMim. Cr. Im 

T^K blBI^ AMD CflRIS-riAM LIFE. 
C'.ltw b. 

LodjM (Sir OITWPl, rR.S. THB SL'II- 
ilAXte or HAJTH, ALUeU WITH 
SCIKNCK; A Ctudnui fai PuwiM uul 
TacbBi. rmf* SA'limn. Cr. ton u. M(. 

UAK A»D TllK UNIVERSX i A Srviir 
OP nia iHriuiHca or ma AorAiKa ini 
SciSHTiric Khdvuoi^ uroK <w> bhii«>- 
(TAHDiwi o» Ckiiiituiiitv. JVSaJ4 
tuiitu^. Drwntr*. if-nH. 

THE SURVIVAL OF HAN. A SritOT w 

UKKBCMXIkEU ItUIUlll FaCVLTT. /'MItM 

jriMHW. Dtmf Bwi. r'- ^ 'Mf. 

LcrfthoilM (W. P.l. U A. ETHICS AND 
AI-ONEMEKT. Willi ■ FraukpWt. 



LoHmap (GeorM HoraM). 

PROM A SKI.l'- 



..»„-,. LETTERS 

.. .MAUK MKRCHAXr 

TO UlS SON. lUuiuiiel, AV^M^vJA 
£JitftH. Cr. Km. tr. (U^ 
OI.U COROON OAaHAIiI. lUuunaM. 
SramdEHtMrn. Cr.tf*. U 

L(M4ni«r (NomtAI, HV TIfE WATERS 
OF KQYIT. lUuuntnL Dimf tat. lU, 

H>. 

LOCUJS, v.). THB UPB OF CHARLES 
[JtMS. lUurtnud. ./V^4 «rf Xn^tJ 
fi/f/uw ■■ Cw VtitHKr. Dtmtf trt. ft- 
6d.mrl. 

A WANDKRLS IN IIOU.ANO. IIIm- 
mud. Trt'nk f-J^tiiK. Cr. trr. U 

A WANDKlUlK IN LOMI^UN. tUuf 
mt^ Ttmt* JMrim. Cr. trt. e>. 

A WANI»IUA IN PARIS. IlhanMKL 
SixliSdk^m. Cr.tBt. Si. 



A 2 



lO 



THK OPEN BOAD: A LkiM Boot far 
Whytuv*. SrTrmlmli KAtitm. tif. 

THE rRUtyDLV YoWSi I • Unb Beak 

u- : /mEh F»»*', w - '-^ 
PISt^tDK J^O SUXSMIKIL £to(t 

CHARaCTEK and COUKOY. iiMlA 

THK OSNTL^T ART. A Chtic* et 
Ltam br ExoMnioc Hiote. J'iMt 

A SVAN AND MIltntiSNDS. IB&- 
(nwJ. ttimji Ini. im. M •//. 

HER INHXHTl VAKIETV ; A Frjnjrixm 
rcnuii Gjuluv. A/c4 Editim. 

LISTtontR-^ORE : Am Oui«vb lit.*- 

■ATiuH. si/ka eatUm. /w- *h^ >'- 

GOOD CO).fPA,SV-, A lUur » UtK. 

.Tion/ Kdiiin. Fsm*. tak u. 
ONK DAY AXD ANOTHEJL /'rarhl 

OVKR &BMSK'rO!«'3^ Ax KmoOwog 
riraiTirtt XvAi* Sdliimi. A<^ ■». 

M. is.s TtrK TiioircuTs or xkcik 

lIAllLlfAY. WU lOH «r iMt Un-it. 
bib*! Iv (t M. A^tw. M.UiHf. 

■■oaalM J-Mdl- OUTICAL AND 
aLSTSklCAL tSSAY& BA*«1 by V. 
C H«Mi«w«. ILA. TAnM ;'«/-»«. 
Cr.lM. lb. 

■eCUM UoMbW Ho»«-rfr Vnj. Rm. F, 
AVT.wv, nsr.). THK DKCAV OF 
THE CliURLII or ROMt. ^<oW 

■eCtillMli ('nBeW. ThtFailtf AbdiJ. 

lluud. UlMrMtd. Cn>/ Bm. •(><. U. 

■teCvHI fflOTOlM A.V . UAKY 
S^njAKT. UlaMiMal. Hrw a-J Q^iijtr 
S^titm. L^rjr Cr. t*«. 6tf. 

■oDwunll iwntUmV M A. rOroi., kr.B. 

SSuutk). A.W l.S(ROI>VClION TO 
SOCIAL PS VCHOLOcr. Thf^ EJ'ti''. 
Cr. •*» it. til. 

'Hdllft «eri"iAuUwror. ST.CATHRR- 

ISK or .StVNA AND HER TIMKS. 
Uhunsnl. Siomd Editii^ Dimy ttw. 
|f . U ••/. 
ItlivUrlliick (aMU-loe?. TirR IlLUE 
UIKDi A fun I\av ih Sn Acn. 
TnulaMd bv Alizammx TEtniiA t« 
Ujirroi. EiiMmlA £itiHnt. fiDtf. tt*. 
PnACt A'd^i. y. M ml. AUt ftaf~ •>«. 
nifrr^avrr^ I J. ■rf. 

■AhABVjJ. P.J, ' ■" f- A HISTOBV or 
TUB ECYPT OF THE ITOLBUIBS. 

[ll«liW«d Cr. trA •<. 

ElItEUHl r. W.), M.A., LUD. ROMAN 
CANON' UW In IllECUL'I^Ctl OF 




Methuen and Company Limited 



MANit (R. %.\ VLk., rcBo> m4 Two rf 
K<e!et C(>nen, Oibd. THE TtlH£& 
Hl)L[>0FR£i4C10}<. Cf. tw. 

Bitnioil .CharlMX A SPANISH IIOLvi 

L>AY. Illwuatcd. D*mrt^^ iw^MaaCJ 

■arrWt (J. A. B.^ M-A. TWK UF«. 
AHU TtUBS or IjOBD palxland. 

7., tiL w/. ^^ 

VAtefleld iJofanl. SKA UTC IM vtt, 

WMS T1U8. mi Ml i^J. O. Im 

A SAIIXIK'S GARLAND. StIccHj ^ 
SdiiM. SetmtiMUtm. Cr. mm. ^M 

AN 'kHOUSR PROSR HISCSIXAVT.I 
StlMnd Hkd Bdiicd. Cr. Ipw. ««. 

TKNSVSON AS A RSI.lCIOcI 

TKACHRK. Sr.-'^t M.ftlifm. Cr.twr- it. 
THE OONimiOM OF KMULAHXi. 
Awrft SJiiint. Cr. tw. Oi. 

■AnwrEUnlCollliimN BNCKAKTCltS 
0>UBn. OtMBUd. iV n) ■■>■ n*.^ 

lU/. 

KuUb UlinttW M. B.|, rtitln •( On 
AadraH&paJ U tiiue. WOMAN tA 

OALJClAi Tv« *——-»■ '-p or Etao. 
lUomMi. iXnrftrr. ni. W ■■«. 

|ledMrLD.J.VK.A, FMfaMttif HlMon 
latbr l7Hn(ihyor<an(4v. ORIOINAL, 
tlXUSTHATIONS nF^KMOUSU OOK- 
STtnrnONAL lltSTORV. Cmovmim 
A Smiactmo Kdhbbs or tm* Cam* 
Cluimt AutSTArviaA Cv.lw fi.U. 

■•thuSD (A K. S.I, U.A. TRRTILACEOT 
OFSOLtil AFklCA. Cr.tpai. h. wf . 

KNt^LANDS RUIN I D«»RW» a> P»c 
Tttii Liircu TO k 
.%'ir.iA iEAJA*. Cr. !■•. ^ mcT 

■«ynAlI iSMf«f4J. OOROT AND KQ 

■M. 

10)M {Busteeet. U.A. UPB ATrKX 

LlFBi «*. T>a Thiciv or »— — ftri- 

TKMf. Cr. iML u. ML mrt- 
TUK fOWEK or CUNCC>fT1LAT10N ^ 

Haw r« AcQoau it. nirit fMiim 

Cr. IWL y. Ml ■■«. 

■lIlKb U' ej THK Un AND LTT. 
TKK-S OF Sm K)H» ETBRCTr 
MllXAlS, PnMiM U\ha Ronl ft rail wf 
Uwounl. A*!* XAtitm. Ann IM. 

A RI5TORT or 
._ . - ^ ROMAB BUUt 



"as^iif- ll»p'^■i^ 



General, Literature 



II 



■Itton l& B.I, JAHK AUSTKN AND 
HEft tlMKS. UliKlraiKt SttmJ rmi 

■vDM (MmtH-I- QDEBN LOUISA or 
fXuaSIA. UloMnttiL nwt4 KJitimt. 
Q'.H*. «r. 

■mnr JL. Cblonw, RICHES AMD 

POVUttTY. XfMi XdlltM^ Cr. •)•(. 
II. Hit. A.l<« Onrrr (v. V. •ft. 
UONKV-S FISCAL OICTfONARY. r«H. 
Z)tmf Ib» Stand SJiltH. v- <-l- 

■oops fT- Stunt*) ART AND UfX. 
llIuiliiMd. Cr, Im. y. mi, 

■oorboiii* (B- HAlIaml. HSLSON-S 
l-^DV HAMILTON. UluxmwI. .!««/ 

Moimn IX Bl, M-A. TIIR IIOUSK 
or LORDS AHD THE COWsTrfU- 
TIOH. WUra iMfBdHlioDbyiLi Lots 
CiiAKauiiw. Cr. itiK tr- <hu 

■onoD lA. AsdtKon). Sm Bnxintk (U.}. 

ll»Pinr lA B J. IJAPteS- PAtT AMB 

Puuirr. illiuuntcd. Tlinirf BJiiim. 
Ct. trr. tt. 

Oman iC. w. C). MA. PtUn or au 

&g»lj', Oi/utd. i HISTORY OF Till 
AKT or MAK IH THE UIUDLK 
AGKS. lllMinanl Jirmt »rr. ut. M 

KNCLAKD BEFORE THK NORUAH 
COKOUOT. Wiife Mat*. 5««i 
SuakfM. i)0V*M. lot. tiCmtt. 

OxCtord (M. K.), or Oay't MetiOia. A 
HA^fiiAOOK or MUKSI^^a J'i/U 

XJlllir^ Cr. Iv*. )K ML 

VKkM (W- C. C). THK SCIKKCt OT 
aVGIENK. lUiuDiud. Dtmytv*. ml 

PfcrkW (Bne> THE BOOK OP TBS 
ZOO; III 1)41 HOD NiciTT, llIuttntuL 

fMnOQI pn. C.1. THK INCOUPAH- 
AULK ilOl>OM:>. UluMnU*d. ilViR/ 

P»lmor« ;IC. Al THE COURT OF 
LUL1UX1II. Illax -.liA TUr4£4iti*a. 
Dtmy tm. j^td-att. 

FkttVPMH [A. a> MAN AND NATURE 
ON 'rll>AL WATUKS. tllulilli4. Cn 
(m. Ic. 

rMrt* IW. M. Ptioiteni, D,aL.. LLJl.. 
rioUiMt •d BnMuInn ■( UuimtiiT Col- 

Uc^ A iiiSTOKY or lovrr. tuiu- 

tBMd. /• At* Vtltmtt. Cr. If*. W. 
«wA 



Va(~ L rnxK m Eailiot KrnM «■ 

XVIth UtHUTT. .C£n4 ffWTyiiM. 
Vol. U. Tua XVIIth ud XVIIIth 

Dtm ut, u. Am>i4 BiUtii». 
Toe til. XIXt«raXXXT»Dn.A>m. 
YOL. IV, Korrr mi«i iiu Pthluum 

OrxicTV. J. P. MuiAm, LM-O. 
Vol. V. fi^rt «fii>sa ft«UAM Kvia. J. O. 

Uuj>m.M.A 
ToL. VI. Eovpt la *■• HisoLB Aon. 

STDHtir LlMS.I'OOLI. H.A. 

RBLIGION AXD CONSaiKCE 11* 
AMUKHI eCVPT. Ua<u«a dtlimtJ 
(I Unlmidip Colkg*. LaodoB. QiBUMed. 

SVRIA aXD'eCVPT, f ROM THE TELL 
EL AMARKA LltTTRRS. C'. »m. 

EGYPTIAN TALE& Tmnibial Irani tU 
J'apRi. Fi(i( 3<m«, ivlh M milk DTntu*. 
B^fivdbxW. M. ruxuutilVncc Hhu- 
tnttA. SKriJ £ilit/rn. Cr.tr*. u.U 

BOYI^AN TAI.K& Tnoduel fram lU 
Papyii. SHuad Sttiim, m^Kk la imtk 
DiTiMtT. UhiMncai. Cp. 1m. u. eJ. 

EGVITIAH DECORA-nVH ART. A 
Com* «tf Ucnns Alhartd M ibe Rord 
lauimdoa. lUuBauA. Cr. (mi ji, «A 

Pbelpt ,BDtb S.>. SKIES ITAUAN; A 
LiTna DnviAn >i» TiuTu.ua ui 
I r<j.T, A'^. Siw. v '"■■ 

FhythUn [J. Ernutl. TREES IH MA- 
TURS, MYTH, AND AST. IDdmomI 
CnlM. *«. 

P»dl>«ra (FnUlk}> MODERN SHKtT- 
UAI.I.SU. -m frlmwu*. Dm7 Im 

UBSUEKISU AND CUKISTtAN 
SClEXt'E: A gb«M Hinoy ef Utnul 
HmCiii, J#Mairf AfttHM. Dm^ tm 
Ml. A^wt. 

PoQwd {Alf^«4 W ^ SttAKESrSARR 
FOUOS AN 11 tjUAItra<L AStBdrb 
I)m Uitllafrtebr rt MaiM|«an*i PbTi, 
■SM-tUf. tUiutiUMl, /a'h. au. tKt. 

tovna (ArtliitF B.}. FOOD and 

IIKALTH. Cr. »H, v. U. lul. 

Pow«p[J O'Conrort. THE UAKlMGOr 
AN ORAiOS. Ct. ta*. 6i. 

PpIo»(L U,M.A.. rtflBwoCOnrt OfTktt. 
Owe. A HISTOHV OP EN-QUSH 
POLITICAL ECONOMY PROM ADAM 
SMITH TO AEXOIO) TOVNTEK 
iUHEJHiHt. Cr.lM U.U 

rullon Burrj [B-J- IN A CERMas 

COLONY: U, toci WnKi ix Nio 
taiTaai. IBBUnud. C>. Ih. ti. sir. 

Pr«r»ft IW- P). BIRD LIFE. nloHBlcd 



IS 



Mkthuen and Company Limitbd 



aVo Ills ITALY. DliutralM. »<«/ 
iT* iti- 64. mrt- 

■R>p[>T>M>rt(An«*toS-l. HOUKLirEIN 
kU^blA. lUiiunud. Dinrtnt. tt*.6d. 
mit. 

B^na-Um il,). S« Llinlly* (0-»>. 

Bftwllixgrn (GMOmdel. COINS akd 

now TO KSOW TIIEU. lUuuniW. 
r^W MJilirm. Cr. b>. fi. iwf. 

Bm [Llllaii!. THE I.IFR AND TIMES 
OFMAKlt: UADELBINK COUNTK8S 
or LA FAVCria. lUdHnMd. A>>v 
•fW. lOJ. i/ M/. 

Bead \C SUmford!. M «. (UmLV 
MH-CS, L,h.C.J-- PAftS ANDr&U}- 

R«M a. D.}, CI.B^ U.P. TBK RKAL 

Batch ffimin. Dmm> Jwfa. WOUAN 

THKOUUK THS AGBS. RUunMit. 

R«ld IAp«hdMll), U.B. THK LAWS Or 
IIEHKUlIi'. SkuU £4ititn. Dtmf 

Blctkmond EWIllndl, Oaplils of Useols'i 
tun. TliS CKBtO ■ " 



IK 

•I. id. tut. 



TUS 
KI>UTLBS. Cr. 

Bot«KM)D (A). D-D, Ixud Bubop ol 
£:»■«> KKOSl/MUKl. I'Du UftBlilM 
Lieiiuw tt tv"-\ •* '*'*'* ■•' CA<B/>r 
MditifM. Dtmf Iff. j(. 6A wy. 

BotoFUon (C. Onntx U.A, rtiia* or 

Ail S»ak' CVDmMb, <Mitt. SELECT 
STATUTES, CAsk& AMD CONSTl- 
TUIIONAI. DOCL'MSNTS, !«»-(■)>. 

BotmrtwBtslr c s ?,K.cs-i- chitkali 

t1t» VTOiTT UP A UritotStitoit [UotlraiCHL 
TliitJ EA'lifm. Dfmr (»•. tu. &£ ■<<. 

BM (Fr«dt. OLD OAK FU'RMTintB. 
lllutCalcd. SttnU satin. l>ttmj \rt, 

B0f4»-Sniltil W- Qh TKK flLiOW 
iTrxjKi A CAi>Ea or Mmtt Uwm. 

CcllKHd. StCBti XJiuaH. Cr, Im. 

F^KTS OF OUR DAY. WiiOti. aitb ■■ 
lanodDOicm. Fiaf. Im tr. 

RiualMJd rrti* RlgTit Bon. Sip Bor«ee\ 
Iljf. . C. C r ij. CMC. TUX 
ADSTKIAN COllKT IN THE NINK- 
TElL^TII (. E K r U K Y. Ulutnud. 
Sitmd KdiCbut. DtmjU*. ill. mA 

BuiMll (W. CUrt). THE tIfE O? 
AOMIRJX XOKD COIUNOWOOD. 
Iltuilnl*d. frmfi Sditim. Cr. Im. U. 



St. rrkMb «f AhU. tub UTTU 
rtowtua or the cLORWin 

HESSUt, AMD or HIS FRIAB& 

Dm« imo KuiU. wiai Note> bT Wiuuia 
UcrwoM. lUattEU*^ X-riv ta« }>. ■■«: 

'S»M ' CH. Hunrol- EKGIN AUi. Si- 

RKGINALO IN SUSSLA. A^ 

SKndem dJoid). THE HOI.L 
HOUiat CmCLl. IUa>u>i<d. 

*S«oit lEmeiv. TKRKi: Hak>I.£om, 

AND IIIK KXPKDITiOX Or HIS 
COVtRV DESPATCIIEU TO Alts- 
TXAUA BVOHUEROr KONAfAftIS, 
ilso-tlw. ISmmiad. Pimr H« mt. U 
■rt. 

t«flB«KiM(HiUhdM. CRICAT RAlJua 
tltiMM. iSiiv fM *&<. U mC 

Svlotu (BdnrandX TOHBdy surrtt*s 

AMUALS. UuittilvJ. M/nmUiMM^m. 
fa*.t»*. u.U. 
TOMMY SMITH'S OTHKK AKIUAIA 
lUiumMd. /VU fdifiiM Awk. b« 
M. U 

•SUtep 8m« A.I. A. WHITB FAnJi 

GARULN. UluHiand. XImvIk fcW 
art. 

Stuli«»6iir«(WimMa]. 

TIIK rOUR rOLI£>:^ lAq; .«yi m*; 



^11 TU' mdt. 



THB ronis or wiluau Shake- 
speare. WMb ■■ laovduccis* wd HMi 
by QiHHBaa Wtmdiuh. Z>n»ti*. Ji^* 
Tam.tHl t^ xv.id. 

rom. 



•■ £lnQ IPiL uf. Ai wf. J 



Shup (A-% VICTOKIAH 

SAlita. 

Slm« tJotinl- Sm Lkda BmIu oa An. 

SUdon ;t)ouKlRf> HOLY: ib »„ 
Winift R(k<:. llltuniEad. i'ttmtd MJiiu^ 
Cr. Iw, y. MM. 



tad BtuDooaa NoMc b* Eiiwra Ckvhu 



lUL 7W»-Wiaw>. 



Smith OoDbbiS). DEAN SWIFT, ihr 

muA Onv W. ua. Ul km. 

SmU CF. J). A SOOK OP EXMOOB. 
tll>MiB(«L Cf. Ip» 6>. 

■StMSlUh ■ GOLr IXYSAlilD DOl 



General Literaiurb 



SUnd iFmsehi B.), M.A. now OLD 

ACK rKNSIONS BKGAH TO BB. 
I HoaWMad. Dnm^ In. t^U. mft. 

SMvWKK IR t-i. THE LRTTKKS OF 
flOtlEKT I^UIS STF.VKNSON TO 
HISrAUILYANDrKltS-DS. Sthac-l 
Ud E4>l«lbTSirSoiir(v(;oLii!(. .Viitii 
FMHtu. TWfWmmti. C-. tri- ie>. 

VMUIUA LETTHCS. With m KichH 
Pntiaii hr Wit i,UH 5t*4i*<^ E*£^^ 
Kdltttm. (V. fcA JCi.r*'*-. A>. 

THR LII'R or K. [-STEVEKSOX. Sc* 

suvenson <■■ 1 1. rROM SARANac 

10 TIIK MARU'-j'I'-SAS. rWnt L*ti«i 
•milvB b)> Mti. h. I. STirtmon doiiaf 
■tl? a Cr. tst. t>. luL 
LETTERS rROUSAMOA,->*«>-U. fa\lt* 
>ad amu*d br M' C> IiAifOua. IIlu- 
InMd. Ana/fi^iUn*. Cr. Iv* «r. wJl 

SUnv (T«rnea P.l. U.A, C«» af V)*- 
chMl*r. DEVELOPUKNT AMI) 
DIVIKS niRPOSK. Cp.Km )I. wf. 

SlroklAIM nt A.V UOntXM MUSIC 
AND UUSlCIA.Vfl. Illii«r»a. ^no*' 

Swmnum (E. W). ruNOi ASD how 

TO K.VQW TJIKU. llluAraifd. Cr kv. 
Cf. vr. 

■Srkei (Blla C). fERSIA Aim ITS 

f-EOrUL [Uudnlcd. Dtrnjitr. tot-tJ. 
ml. 

SrmM U Ej. 11^ THE rRKNCH 
KKVOLUTION. Sttmd JMIt^ Cr. 

tRbw lM«tv«r«t Kl THE SAIKTS IN 

AKT iiiuiiiittd. /"ra/. Nw V. M ur 

Tuln- (A- Bl THK ELEMENTS OF 

TKvlor iJohn w.\ THE couiKo or 

niK SAIN'1%. 1)l«n<w«J. liimit *—■ 

J., &i ittC 

ThlbAudwui lA CI. BONAPARTB AND 

TlIK CONSVLATR. Tnnilslc4 (nil 

EdHcdbrtr-K tomvcfi, LUD. IIiuc 

tnMd. Drm]i tr*. txu. U. mt. 



V-nb 



THOMPSON. 



. WUb • PntiM ia Pkolacntvn. 
•MKiii*. Ai^^ (n }(. x«. 

IteUWlEWT WJ. DAILY STRENGTH 

Aba. JVtritaa iSmk. *r. td.mit. Aln u 
■dUoB ID lop^or bin^At, f^ 

T«rDb*BlPac*t,UA.,D. Li>t. DAMTK 
In EN&LI:iU IJTIliRATlIRIt:rKOH 



CHAUCER TO CARV. 

TraiMlKHarbtrCl. DBIRHRC WEDDED, 
AHo OTRH Fvnn. Snmd tmd K*vmtd 

S'RW FOKM& SMtmd EJitim. Lm-rt 

I-ratr*. Ai. 
AfOLLO AWn mS 5SAUAN. Z^-x* 

Put tm. Pfrr. u. UL iff/.' (Mt, •>. b£ 

Ti-avolrao [C.n\r,0<n,tiTAAnCMitt*, 

CuaUiln. UMOLANO I'VDER THK 
STUAR^ Wkk Map* uxl Plus, i'wvr* 
£ J Ui m. Dtm^tn*. n*. W. wi. 

Trln* InliO R!. A.S.I.R-A. TOWN 
11, ,» .S N T S (i : fi!T. I'maiivi, a>d 

TAuffiAii iH«rb«rt ■■:. R.A.(p><«\ r.S^ 

THKIJISTOF THK ROV Al. STUARTS, 
lltNKY STIAR r. CAKUINAU DlfKB 
or VORK. lUuiE/aWil. ^KM^ AaVJiiM. 

THE MEDia POPES OKO X. Am CtE- 
UEVT VII.t. IUoM»t^ i>».r >>*^ <tn 

THE NAPLES RIVIERA lUntraMd. 

Stttmt Edilim. Cntm. Of. 
•FLOItRNCIt ANl> IISK TKEASVRJU 

Vernon (RoTk W Warren', m.a. read. 

INOSOK THBIKFERMOOFDAN-JX 
Wlib ta iDUodMcdM br ib* Rn. r>a. 
Momn. Tv* frlHtmit. StunJ lUtiira. 

READI.VGS^'on' THE PURfiATORlO 
OF UANIB. Wlih IB iRTtalBCIian by 
ihs Ul* Okah CxLircit. fta* Cirtiin 
Tii'J KJ-f-n: t"r. *;*. iw. Itrt, 

READINGS ON Tilt; PaRaDISO OP 
DANTK. Wwh m iMndxiMi bv lb* 
RmHar or Rirhi. 7W* ^Wkirn. Sittitd 
KdilUm. CV. »w. 1^ <»f 

Vincent (J E> TMROUGB EAST 
ANCLIA Mi A UOTOR CAR. ni<» 
mi*j. C>. bA if. 

WiiddBll JCol- L-AVt'[*I>-.Cn- LHASA 
aKU Il-S MYSTERIES, xv^h ■ Rcco.d 
•f(h( Bnwliti^ •( it>n-MM. Mlv-tnMd. 

II. bi. mt. 

W«cn*p miehArdt. RICKARI> VKC- 
NLR-S UUSIC DRAMAS! laNrjiitu. 
(■(■■■ ■Bbodirtnt Wiinn'* on otluf 
tioat. St Alkb LiiuHTi'N Ct^Aim 
■>■>« HaiIi. C(U>r. /■ r^rn VtJvmiM. 

Vol. I.— Th« Rihc or nil MikIiIiso. 
TMrdiJUi. 

Vol. ul— Tiutah am Imlob 



IK b'lNLANb. lllitUiKd. Df^ Id* 

■Of. fr^HM. 

mtiVMIt (A. B.I. ORAUA AMD UH. 
Cr.lM. «•. 

W»twh*ow (EllMbetli; WITH TMR 

SIMPl-EKKARTF-n: UuU llcjiiJwrHo 
Womn ID CrunliT ViMoa. i'nr^ EMiifm. 

COXIPANIWSS or THE WAY. B*1m 
St>«tlan> rg( Manisc ■»■ E'V^'^E lUril- 
Iak. Cl><«tn uid anulsd br Kluai>*« 
U jiTiu Hataa. Xdivwt'.lB*. u. *ff . 

THOUGHTS OF A TSSTIARV? J-wrf 




Methdbn and Compakv Limited 




5« H<aJ«tna(T.r}- 

Wetoill UlpOiuf E. P). A OCinE TO 
THR ANTlyyiTlES OF VTVF.K 
K(;VIT: Frctt Abydoi u iIm SudaB 
FrMlia. IDuiinHd. Cr. ttr, jt. M. iwr. 

W«letl iCAthiPlMl. THK LITTLE 
DAUrillH. lUuimUd. cy.tow. b. 

W«U« (/.). MA, FtiJaw tad Tals(<rfW«4> 
kMfifli£t*- OXrOftD ANDOXrORD 
Lire. fkirJ Eiilin. Cr.t9*. V** 

A SHORT HISTOKV Or KOHC- Trili 
XAan. Wiih j Uapt. C*. (M. t>. 6^ 

Wa»Mll (W. P«r«1v«I). THK roUHO 
NATUKALIST. llluUHUd. Cr-. t«h ««. 

Wtrtoli iw PoM*T«i}. '-US., M.ao.u. 

>nd CDMHir IC &S r.R.n.S. THK 
YOUNO BOTAKIST. llliuuaui. Cn 
tfW. )«. U w>. 

•WhWtor fBthel K-k rAMOlIS SLUS 
brOCKlNGS. lUnMnlbd. £>nv fc* 

<gf. u: oW. 



WhIU (C»<ir« p.), Li-I-Cd. A CKW. 
IL'RY OF SPAIN AND PORTCUAU 
■;ei-iS«L Drmjar*. tu.*d.arl. 



triidsjQsevt- i>B rRoruNots. 

IKt WOKXS or 03CAK WILnB. /- 
rWrhi t'rJmmtt- Jt^f- Imt, fl, tut IMet 

[. LoKD AtTunc SavtU^S Clllt* AM* 
Tw» PorfBAiT or Ui. W. H. n. Tim 



Dvoicu or Paoda. m. PooM- 
Ljut* WunMaHUB'ii Vaju *. A Woa 
or K« laxwrA-nrs. »t- Am Ii«*i. I 
•vr. vn. Tub IxroBTitiica i-r 
KoinatT. rill. A Hsuts or 

OrAKATBIL tl. llvr^TI' 

retrsn «iid P> iioh L« i «— «. 
III. Kai/iw(, a Fi.0BKimii 
lod L* Samt* CMnma.iJK 



Wniliim< !H. Kd«I>- ths wowki 
BpNAI-AHT'KS. TlH MoikB *h1 Anal 

A ROSK or SAVOY : If <■•« AokCidb i 

SaTOV, DouHUEia lnS tlatTHoocIia. lj<mM ' 

or Loan *v. ltJud.-iKi. JmhW 
SJilim. liimf tr*. I v- *•'- 

THE rASClSATlNC. DUG PE UCH>- 
LIEOi Ln-.ni fiiHfoii AmMAm »■ 
PLcttu^ )li*k:iiii. Ovc tia 



Wood sir Brtlyai. r. M.. 

ft.c,»ro. PROM — 



MiDsmpti. 

FIiaD-HARSIIAU IllM«rM«L 




THE REVOLT IK UINDUSTAM. ihr- 
» lUoHnud. Stcmd/UMm. Cr.miTu 

Wood (W. Blpkbeek'. M.A.. U>. Brt.Wrf 

ahJ«r / BJ. R K-. IXA.O^HA A 

HiTryRV nr thk civii/WAit li 

THE UHITUU STATES WUl « 
Ina^MfMB br H. $psma WlLCUiM. 
Wfeb ■« liapi ud Fbu. rXrW r-^'- 

WordtWSrU IW). THSroUCE. «M 
■A iBimiKiaB aad Ksu* b* U | umi 

Oifard. /■ r^kw IWbiml Oh^^k 

POEUS BV WIUJAU WOEDSWOltnL 

K*l*d*d with kB iDirodvaiott lii "lilnijoi 
A. Uwoci. tUiiic>U4, Cr Im h. W 



WrlU. (■- A.V HORWAT AND ITS 
f I0R1)&. lUulntad. .f«MW fT^-f-n 

Terse. xrmuJ md KmU^^^ ejui^ 
Cr.tM. i«.m: 

Toanc (FOmiiI- B« Tk« CMi«>m* ShIh. 



r 


^^^^■IH 


■ 




General Literature i; 


1 




Part II. — A Selection of Series. 


H 




Ancieat Citie*. 


^1 




Gtneni Bditor, B. C. A WINOLE, D.Sc., F.It.S. 


^1 




Cr. 8t<#. 4i. 6d. ia. 


^1 




Vfitb lUnstrBttoTU b; £. U Ntff, uid oib« Aitiiti. 


^1 




RaitTnt. Bt Alfr*>I llintv. hf B. i KerFlil'tieM. By U. G. HHIiaininii. It. A. 


^^1 


CAtfTUiuvV. Hi* J. acv-, U^a. F.S.A, 1 tjMCO[Jf. Hv £. W jbhI Stdioua. M-A, 


^^^1 




CmaTa*. Ut B.CA.Wimlle,D.Scr.K.S. i Shuowoit. Ihr T. Aodaa, tIJU r JLA. 
DuauH. Ilf S. A. Q. f tufairl^ ' Wbiu uj Oi-i^tronaiaT. ttfT. 9- HelniM 


^^H 




H 




Tbe Antiqu&ry's Books. 


H 




G«iMn] Ediiot, }, CHARLES COX. LL.D., F.S.A. 


^1 




iffmy 8*#. 7/. W. mtt. 


^1 




Witb Kmneroui lllmltatioiu. 


^^^^1 




AftfHAOLO^T AVB VjUAA AHTiqUITIBk 


Gei tai Awe CourAHIM <V LQiKtoiffi Tmk 






Br R. Hsitn. 


lEy C«ar(« Uawi0. 


^^H 




BsLU or RHOUkitn. Th«. Bjf Cu»b J. J. 


MjLKoa Airo MabokiaIi KacoaiH, Tua 


^^H 




RsTdb Srta^J £Wr/H«L 


Bt Ifdhuitt J. HoM. 


^^^1 




Siuiu* er BHCLJ,ini. Tan Bv Habot 


Utiiiavii. HofnrAu or boLAMO. Tmk 


^^H 




C>LTic Abt m Paoam ahd Chkutuh 
Tim*. Br ]• Romillji AUtn. 


Bf RoLhi Mary Ctiy. 
OiA Soancc >ooiia or tns £.11^1.1111 

Cin^acHv Br ChrittDph«r Wor4twlb, 
M.A.. and Huiy Uulclulu. ^maJ 


1 




DoHUDAt lN4niT, Tmb. 0« Adtlpbus 


^^1 


1 


HallaTd. 


pA*iifi Lirfl TFt MilorxvAL KpiCL4)ff>. Bf 


^^H 




EjieuMT Cmitrii Fuimiriiiti. BrJ.C.Coi 


tbe Kichl Kit. AbbM Ca*qMt. Sttmi 


^^1 




■Dd A. Iluvcr- JTa i-k/ Kdllbm. 


BiUcitK. 


^^^1 




Kxcutii Cottx'Ms. Fiuffi r>cbUurtc Tbita 


■Paiiih RaniiTDs or bBLam. T«i. Br 


^^H 


J 


H ih* End Bl iti* KifhiMMb CMnrjp. Uf 


J.CCoi 


^^H 


1 


O«orst Quch. 


RaMAtm or tu pABHiimatc: Acs (■ 


^^^1 


1 


Brgluh MoKAtTK LiFK Bjr lb* Rishi Rc*. 


RHOLAn. Br B. C A. Wind]*. Srtmi 


^^M 


] 


Knouiii Sbaia Bv J. Kw*ay BI«ob. 
rau>t>oa Axjiii HiiixaiCJtt. Seine*. %r 


RovAi, Foicrn or BiiauMo, Thk. Bv 


^^^^^^M 




J.CCi. LLD 


^^^^^^^M 




Zitii.lt, Connc 


Smimh or S*i 1 itH SaiMTs. 9r J. C Walk 


^^H 




Ths Ardon SliEikQspeart. 


H 




Dtmy&tv, u, U. mfleMk vtikn/. 


^1 




Ad edition of Shkkapcwe In lingk PU;*. EJlicil wilb • full Intfodieth*) 


^1 




Tatnkl Nolc:t, Biid a Cammtnuir at tbe foot o( [he luge. 


^H 




Ait't W«u. That Eio* Wau. 


UioiuiLC roa Uaai<.->x. 


^^1 


1 


AVTOn AMD Cl BOrAIH*. 


MttfiiiHr or Viinrt. TrfX. 


^^^1 




CVMlBUHb 


Mixar WiYii or Wixmoa, Ta& 


^H 




L'oHUiT or Elunu, TmB. 


UiinUMuaa KHMt'* OaaaM, K 




Htw-T. Xkiȣ Bi^etrm. 


OToauo. 


^^^M 




KiMo tiuav *. 


PaaKun. 


^^^M 




Itwao am Jsucr. 


^^H 


', 


KlMC Iluiiif Tl. Pt. I. 


TAmia or ticb Sjiavw, Tk^ 


^^^H 




KiiM Hamr r\. Pt. ir. 


TWurwiT, THr. 


^^^H 




Kim HsiRT vL Py. ui> 


Tixoi a* Armvi. 


^^H 




Kims Lbar. 


T1111* AnOOSICVIi. 


^^H 


l' 


Krm? HiorAHD rtin 


TlDMlOt AMB Chkmida. 


^^^1 




Lira jiNo I>aATM or Kiiio Jatim. Tnc 


Tno GamLaxHir or VaaoHA, Th» 


^^H 




Len't L^Bova'k I'OiT' 


T«nm NioHT. 


^^^1 




liliic»ni. 




■ 


ta 


• 


1 




HintlTiooki of IngtUh Chnrsli ShUiTj. 

Edited br ;. H. burn, B.D. Cmn Sm. u. w mm. 



k 

^^B Tm FanwTiAnoin or «■■ Emuiii Cai>ct> 

^H^BWi Sxtiii CaunCH HUB m NoaiUHCaw- 
^■f gi»ir, Br C T. Cxwiatn. 

I I Ur *. C. JuuiBi^i. 



T>n Cni.'tcii or tirei«Kf> m im Tin*- 
TUWTH CwrrtBiF. Br Utfi fkmmtt. 



Tho Illutrfttoil Pocket Librar; of Plain aod Coloaisd Bwka. 

Fm/. 8m. }i, tJ. mtl tatA vt^mt. 
WITH COLOURED ILLUSTRATIONS. 



■ 



W. Itrf. 
TWm Lm AHB DsftTH OP Jo«nr Mi i lOtf, 

Tk* Lits er n SromuiUL By Viitnt. 
UAiinuT CaoM. Br R- S. SMIHti rUirf 

Mb. t n i M* ! Sr«aT¥** Tos* S* H> S. 

$. Svrlm. 7A<-J BdiKrm. 

Aim HkHUA. fty R. S. fim«»» 

TliB AHA»«n or rn Hnmna fist*. ■* 

Turn Touaer D«. SnrrAi m SuacH a* 
Twa pKTUus^i'i. tly WnKut Cavbc 

Tk> TOCV OP Pv- filVTAI Ut SCJhfeCH OP 

i.<iH«oi.ATMii. Uy Wtlkam C«^ 
ium Tuipc Toc^ op Ht- !^tktav tv SKAvna 
•••W.pc. SiWiUiunCs— W. 

Uh Auikw «l • lit* Xhn* TOHV' 
raa Cii«iJB> Diu><s sr Dm*ni, ban ih* 

ni u ii iM i— hr ilw A«ike> «( -Dtdw 



Thi Pamb or Ivrai A Ph* Mr ih* 

Auibw •( ' Di. 6t«u>.' 
LnB m LonsoM. Bp FUm RfUu 
■jul lit** w Lamioa. Hv aa AartaH 

<K«r«i ts»V Tb* »**>»». 

T>M LtT« «• «■ A<T«a. Br fW«a Kp* 
Tm Victa OP WAicnauL a* OUm 

CeU— hk. 
Tux MruTA*T ADruT-.'m o> Jeann 

NaaOMiia. Bt ta Oficu 
Tne Katiohal Sman op Omut BarTAirL 

Wiih D*i»lp>)aaa ukl IsCalMHil PlaM Wt 

NaniyAJkaa. 
Taa AiiTKVTraB* or A tan CAprAm. 9t 

t K'lt^ OiEoB. 
CaW'-o'a. &r l^inWa Rav^iar. K*« 
An AcAOm POB Caomi llo«iu»M. ftt 

Cac*«raaa)MteKa«- 
IIbai. Lira m t«*LA)>B, By a RmJ PbMc. 
Th* ABrBtrrum •>* JaNWini NtwceaiBBtB 

rnNarr. By AVnd Korua. 
Tbb Oib Kiratua S^uira. tjlakKCmf 

To* Kiw-i'H Srr. gy Bnaarf llintMialb 
Tb* fjAoMfi TIL ar<. 



WITH PLAIN 

Ta> Oun I A Fata. By Kobvrt Bbir. 
luumATimM a* vtw Rmk or Jr>a. la> 
nmad aod aBC>BT«4 by WVIh* Olaka. 

CWVU. Br W. HacrtM Ai>» 



vonta. 
r<i ToBn ar Lsmdo*!. 



Hi W. 8*nwM 



ILLUSTRATIONS. 

riAUK FAi*i««B. Byf. KSMvAry 

Handt Ahp*. By laaari Lam. 

Zw» CauHitr Amub. BylBtkWattM 

aod Ckatia CMMB. 
Tin PWKTICK P&iMM. By CtotM tHch 




F 


^^^^^■W 


■ 




General Literatukk 19 


1 




LittI* BooltB OB Art 


I 




iViri mattjt /ItrntrMicti. prmy i6«ri*. GiH t**. %i ^. tut 


^1 




Euh vnlome eoiutkli q( tk^ra joo p«^, Ui<l coDftini bont 30 to 40 llluiliation*, 
iiu luring • F*oaUipic<e >□ Pbutopmmie. 


^H 




^1 




Aunc«TDiTi» ;. Ailea. , Hmmm Un. 0. rsKiaeiM. 


^1 




Am a* JAfilH, TBM. E. Ditlea 


tixvHiHibTSD HAMwenrn. J, W. BmikT 


^^1 




F^AocRATB K. Almaik. 


jKwnujr*. C Oainpaw. 


^^1 




BOTTICBUJ. Miiy U KloOAMt, 


JoKii HamasB. H. F. K> SU|4«a 


^^1 




BuB>im.Jeiia. F. dt LmI*. 


Sia Je«nvA Rcnoui*. J. Sloit. 


^H 




*Clnun'UH SntMut)!. Mn. B. juntt 


Hil4«T. N. Paatixk. 


^^1 




Cniiit ih Arr. Mn. H. /trmtt. 


UiKiKTVUI. C Dateopon. 


^^1 




CUiniB. E. Dillgo. 


Oui I.iiat III AsT. Un ft. /toaci. 


^^1 




CbttniMX, K. W. TanpVlu. 


Ratkul. a. K. nirbunl. ^Hwx' X/lMM. 


^^1 




Ca*VT. A. Pellud >nd X. Stranfaicl 


lUmmHtiT. Uim- K. A, 3Iim». 


^H 




KmiiULi. Un. H. Di*nn. 


Tuuu. F. Tjntsll-GilL 


^^1 




Fhmfjdtc Lifonr^if. A, Cocknb 


Vahovcil M. G. SiiuilV'jod. 


^^1 




Caoica RoHKn. 0- Puuo. 


VkLuTUIO. W, WlIleiJKW ud A. R. 


^H 




Gana Ait. It U. Wiiun. 


Gilben. 


^^1 




Qnnti ajR) Bmkkcm. K. F. Polkrt 


Vtrn. R. B. 0. Sk«ubl«y 


H 




The Little dslleries. 


1 




Dtmy \tm». ii. 6J. net. 


^1 




Back Tolnmc toimini ao pUtc* ir> Fhoiostawc, twctber with > ibort ouliiac 0/ 
Ibt lij« *nd work of tli« mMtct W wbom Ue book U dcTOted. 


^H 




^1 




A Littu Oauam or Rcnroi.»». A Lrma OkUMiT Or MiUAit. 


^H 




A Lrmji GAum or Romicit. A Ln-nM Cuun or Exgut* Pokt* 


^H 




4 Lcrru <]<ua«b? or fiomm 


■ 




The Little Ouldea. 


1 




Wth man]' Iltuilr&tioii* b; B. II, Nbw ui<1 olliw udalii aad from pliotogcApht. 


H 




SmaU Put ^M, gilt ttp,tl»A, ti, 6dL «tf: Stalhtr, y. td. M. 


H 




Th« oinm feature* of iheieGuMa »m (i) t b»nd)r MdchAnninfl form ; (l] ilia* 


^1 




tratio til from phologiapbiand |it vtll-knowo utiliU : {j ) ^'""^ plini ai\A mapi ; (4) 
■s xlcquM* bui cuiiijaci picteiiUlion of cTCFjttiuis '^■'U it intcrtsling in ihc 
ottuiBl fcaiures, tiirtor/, ucLueologf, and uxhittctiirc of ibe tinni 01 dulrict licated. 


^^1 




^^1 




^1 




Cahhi>«s ahd rri DiLMtou. A. M. Sua it >»«■■■'« Co»jit»» B. C. A Wliull*. 


^H 




TbanpaM. Tklrd S^lim, Kiv'jtd. 


ncn^fAWm. 


^^M 




Choubi LuKa, TMa. V. C. Bnbiai. 


St- Paui.'> C*tiiu«au 0. Oincti 


^^M 




InJi or ViiiHT. Tu. Clinch. 


WnTmimn A>*kt. a IL Tiowbacfc 


^^M 




UuiTBU Coainwt, Tub. S>. C A. W1a41*. 


j'mx^ SJilit^ 


^H 




NoHTH w«Lw. A. T. S4er}, 




^^^H 




Oif«*D •im m CotiMM- 1- V*Ua 


8vcKiira«u»iii*s. R. S. lUaeta. 


^^H 




JVAm* KA/bm. CKBXnai. W. U. Rollldiu. 


■ 


1 
1 

k 




2 



Gbnerai. Ltteraturk 

TwaLmtM Limit — jwiimi^ 



31 



■ftrvell lAodrswl- THK POBHS 07 
ASDKSW UARVHLt. 

■iitoQ uohnv Tiu umos roEus or 

JOHN MILTON. 

XolP(D. >.). yAMSIKWAUCR. 

Hleholt U. B. BJ. A LITTLE BOOK 
OK ENGLISH SONNOTS. 

ftocii«roU(mDld <Lk). THE HAXIKE OF 
LA KOClIErOUCAULD. 

Smith (Hanwau4JMB«0. KSJECTCD 
AOORB&SEG. 

Swros iLanpwwX * SCN-nUKXTAL 
J0t;K>4EV, 

i-OBJkfs or alpredTIord txkny- 

SOK. 
IN UKUOklAU. 
nu PRINCESS. 



UAvn. 

ThA«k«rty iW. ■.). 



▼ANirr FAU. 

Tim I'tltmit. 



Tt. SDKKNIS 
CKUtSTMASBOOKB. 

Taaehin (HmQ^. . THt POBWS Of 



COMPLBAT 



NKY VAUOBAH. 

Wiawa llxaaAI. TBS 
ANCtJR. 

Tr»Urh«B» iKIIUltMttal. A LIlTLl 
.... ._ ^jjp 



UCiOK OP LtfK 



DKATH. 



Worliworth fW.;. s>XEcnoNS rRou 
woRnswoRTa. 

Wgraiwortfe jW.I -nil Col»ridff« ^tj 
LYMILAL BALlAUS. 



Tb« LltUa tjouto 81uke8pMr«. 

K)lit«d by W. J. CILAIG. With lstioJucii«n( uid Nat«L 
/Wf ]6<M. /n 40 V-thmui. cm Uf. Liatkn, firiei U. mH m,'A m/hma 



KiniBtan LibiBrj. 

Gilt Ufi. 



ScrilmiMDi I A Dblvu* «■ Tmlh. By 

Tira Lrw or Kd«avd» Lo&d HskBDcr ftr 
CmsiniT. Wfiiics b)r kluuiU. iDnv 
IMM. Ltslitr, u- mil. 



Potonn : «* VIh Sivi ind Modon ti- 
■Moco. Br Edvud FiuCtnld. Dmr 

Edwanl I'itiCanU. frxriA Kdititm. 
L^tlXtr. u. lut. 



Tba New Library of lledii]lii& 

Edited br C. W. SALEEBY, M.D., F.R.S.Edln. Dfmy Siw. 



C*>t OP Tvt UODT. Turn. B> r. Canauk. 

Ri(ti<Maa.S>iJolLBConI. SimUXi'tira. 
,1. &/. sM. 
CoHTaot o* A Scomc^ Th* : w, Ha> 
Oam 11 CoraU^ Br Qua- Y. CkiUc. 

j>. U vr. 
DcfiAict c Oc<vr*riO)i. Sr Sfc Ttiimai 

O^T*r- IOC- U^ «tftf, 
Dtiai PioucM, T«t.la iU U*<IloS«i4< 
lo^ii^ Aipuu Edkcd byT. N. Ka^fimk. 

DtvM AKD *ar Dmn Hun. B) H. 

SaiiubiDr, 



rVHcrroxAi. NuTa Dit»us». By A> T, 
Sciu£*UL T'-d^-^ 

'HixKiiiTT. Tub Law* or. B|r ArcbdaD 

Keid. »tt, mtl. 
Hrciun of itma, Tn. By T. S. Oovmm. 

iKrAirT Miiiriiiir. Br Hii Gavfi Sww- 

naiL jt, td. mit. 
Pacrnrriui e* ToacBcvLout CCowiir- 

Tiai), Th*. By AitltM Kc*iholiM. 

IM. MlwA 
AtS JkKD HULr>. Br BomU C Uadb. 



KICTIOH 



»3 



Tb« VHtninitOT Ocnnionteriei. 

G<nenl Eaitor, WALTER LOCK, D.D., Wud«Q of Keble CoUcc*. 
D«*a lietud'i PiC'kno* «r Exeg«dt ia Um Uoivcnitr of Osfai^ 



TVa Act* or thi Ara«Ti.n- Ki!lt*d by R. 
H RukhuL, U.A. £'fa^ Im. Fifti 

Tm Fnrr Eniru or pAtri m Amktij 
TO TKi Qii]s thiilm. K4iii4 by K. L 
Oon^, MA. SliUEd. Pn^Uv- U. 

TBI Bv^ sr Eiaum. EdlM by A. U, 
M'Nim, B.O. With 1 iilMff tat | Itaai, 

T>a Bocae ur Kuaio. Ediwd by H. A. 
Radfaih, M.A.. DJJlt. S>,mftn. nt-U. 



Jbm Booi or OmKwa%. EAitrA mUb l»ir* 
iaa'wa and N^ttt bj S. X. DHmt, 0J> 
£V*J* edUift. Dt-v W*. n$.6d. 

iDDiTioKiiaDCoiaKnoniiiiTialin'uiM 
Sommi «« Th« Uoo* or UaKuit. Uy 
S. H. Oriva, IXD. ^HM/ (n. k. 

TnMBu9CO*j>?>- tUfMdbiB.C.S-Clbnfc 
D.D. Srand £Jna». Of^f tr*. It. 

Turn EnfTLB or St. J«iia. E4iM vitb 1» 
■radiicttaB •■< Nms to* R- J. KaijRn, 
O.D. SttmitJItit^ Of, In. fiT^ 



Part III. — A Selection of Works of Fiction 



ONB OTHER. 



_ SUSANSAH AND 
fnra S^Usa. Cr. 

■•V. W. 
LOTK AND tOtllSA. Stctmd MJMi^ 

C' iw- A>. 
THt: BROWS EVES OF UAKV. r^W 

EJifin. Cr. tiv. t«. 
I KNOW A MAIDEM. nn^ tjitam- 

Cr. kHk 6*. 
TBK tKTIKCIKLK AM£LLA: oi. Thi 

Poun AorKHTttui. /*AW taUiifi. 

C: If- y. far. 
•THK CI.AD KEAST. Jh'At MJMr* 

Cr. lev. £>. 

Alltrtra (Hark). SUCH &»0 SUCH 

THINGS, t:^. Nw. b, 

ABQUlay (lUudK. THIS DArS UAD. 
miaa. SamEMin. Cr.ttt. U. 

ttMl Cnithftrdl. A ROMAN UYSTSiiy. 
^ktnfSJi/ir^ Cr. !«, it. 

TUR PASSraRT. frwrtJk SUlit^. C' 

TSMi>r\TIOK. Fi^H Liitim. Cr. (m. 

6>. 
ANTHONY CUTHRRST. fr>mA i4iiit». 

LOVE'S PROXY. Cp. tt«. i*. 

DONNA DUNA. .S^m/ </iMm. Cr. 

CASTII'O or METS. Tw^ii fJUfai. 

B«.[l«r<'H.C.) STORKAKDTKEASUKR 
Jitn^ ^dilim. Cr. %f. ti. 

Ball Oona R? rB»W« B«iL.>. THEIR 
OXFORD YEAR. lUiutriMd. C'. •*»««. 



BARBARA GOES TO OXFORDl mm 
MMd. rUr^ KJitirm. Cr. ha. ii. 

BarlnK-GouId IS.I. ARUlKStX, Wllh 

a^'i^m. Cr. trt. U. 
IN THK ROAR OF TUS SEA. Smnth 
M^nrm. Cr. Iff. a>. 

MARGKSY or QtlETUER. fiirj 

JlMtMim. Cr. tH. 4j. 
TB£ QURE.V or LOVZ. fV>* gHH.* 

Cr. Im. U. 
JACQUETTA. TkhtiSiHim. Cr.trt. U 
KIITYALOKE. fifiXXJil^t^ CV.Ih, a* 
Ko£ui. UluanMiL Fi^nAJUMt^ Cr. 

hH. «>. 
THE BROOU ■ SOUIRK. tUoitntcd. 

Fi/U £Mli*m. Cr. tea. it. 
DARTUOOR IDYLU. Cn I*/ U. 
CUAVA^ THR TINNER. lUuoitUd. 

Strrmt £ditu*. Cr.Uf. 6t. 
BLADVS or TUF, STEWFONEY. Ulw 

MMi. Stt*^ SMitrm. Cr. ttm. (i. 

PABO THK PRIEST. Cr. Im. Sf. 
WtHBFRBD. lUumucd. SiemtdMJiUm. 

Cr.trr.ti. 
ROYAL CSORCIE. llhumMJ. Cr. *■>.(•, 
CHRIS or ALL SORTS. Cr.trr. ti. 
IN DBWISLAHD. StamJ JUUitm. Cr 

trr. ti. 
THKrROBlSHEK.^ Cr.tt* t,. 
DOMITIA. inuJOUcd. JnrW XAte. 

Cr. •** tt. 
URS. CURGENVEK Or CVKGENVSM. 

Cr.tr*. tt. 
Buv (Rebortl. IK THK MIDST OF 

ALARMS. TiirJ Kiirirm. Cr. trr. 6,. 
TMR OOUMTeSS TIKLA. tWi 

eiiHrm. Cr. Ih. tt. 



FiCTIOM 



a$ 



MAKGIIV Cf THK MILL. TA/rd t^ 

HARDV-ON-THt-HlU. r*.W Mdtlitm. 

Cr.lH. U. 
CA1-AT£A or THS WHKAirieLO 

Sitrmd Kditirm. c>. Ini, b. 

Fnuor iVr» Ruchl. THK SLAKINO 

CIAN.'JELLA. Srtmd gdiUf. Cr. art. ^ 
IM TITK 5HADOW OF THK LOUD. 

rrr [ft HDdc ftt. A uryTRKR-ssoM. 

Gerard il.«ull«>. THE COLDRlf CKM- 
IlPKDlL T^tvVSJUM, Cr. Ir* b. 

3tbtii jnnip). THi SPIRIT OP re- 
volt. JmwWAAMm. Cr.aML At. 

QlfShW (Oeorcw. THK CROWH OF 
LtrZ. Cn*M 4f. 



Oil 



BwnUtoo ICocmal UK& SKBri'lHO- 
mS in^^SJur^ Cr.tn. «L 

HMT-den SeatrioBl. INVARVtMO 

THE Si.HOLAH-3 DAUliMTER. /rmrt* 

£Mti*m. Cr. ■>■. (». 
UiLSA STKAFFORD Md TEK a£UIT< 

TANCRMAN. Twtiftli Xd. Cr.tr*. ti. 
INTKRPLAV. Fijt\ Aditiim. Cr. •». tt. 

tII«hDDi iRabortt TRK PROrHET OF 
BERKKL^V aOUAKB. Stt^KdEdiUm. 
Cr. tM. U. 

rOKCUCS or COMSCtSNCt. naVW 
EJilint. Cr. »M. t^ 

PKLtX. SnimlX XJitirit. Cr. ti^ tt 

THK WOUXN WITH TKX FAS'. Jt^JI/t 

eVEIk^AVS fr. Iiw. t« 

THB GARDEN OF ALLAH. KimMnU 

Bditi^. C'. trr. Si. 
THK UI^CK SPAKIKt. Cr. W*. &r. 
THK CALL or THE BLOODl S^hmI* 

Sdiritm. Cr. 1<^ 6l. 
BARBAXV SUKKF. Stum/ EJUitii Cr. 

IM tl. 

BUltar* (A*bU»). TURHASTRK^Clttl. 
UtMntoX SttamJ MJuirm. Cr.i„ f,. 

■ope tAnUtony; TH8 OOD IN THK 

OAK. SitrtmAjSUrir^ Cr.trr. tt. 
aCHAKGR Or AIR. SijitSMrirm C' 

•h. e.. 

A MAN OF MARK. 5n«/*«/. Cr.Iw. &.. 

'"y.iiJ.!i'"L>'".-'H "^ COL'KT AN- 
TONIO. .$i;a(A Sittm. Cr. tpt. ft>. 

PHROSa llluu»'.ed titkit M^iOk 
Cr tr* »r. 

SlUnNDAI.K. nia«nMj. EitUhAd,li^ 
Cr. tr.. &. 

TUB lUNCS MUUUllL .FVU JAM«. 



QtTlSAKll. J>rt.rtk fdi'Hrm. Cr. iM X 
THK DOLLY DIALOllUlLS. Cr. •#* *f 
A SE:kYAN7 O^ niE PL'BI.IC- IUm 

miiJ. /'i'»'-i* eJttim. C'. fc". ••. 
TALKS OF rWO PEOPLX. TU^d MJi 

MAa. r-. Ih-. 4<. 
TIES GRUT UIS.S DSIVER. Awfi 

XJilit%. C: Im. (f. 

Bu«rT*r (Fard Mftddox'. AN EHOUSH 
GIBLi A R'lLiiirCB. StinmJ MAlini Cr 
9v*w ia 

MR AraLI.0. A JMT FotHKa Bron 
fWHtfS/tftlH. Cr.liw. b. 

HaUM (Bnrenwt ran). THK BALO 
Utm IC J CuteUmi. HA. HOR 

KOCKS. FVIUKK. >V>A AdUitm Cr 
Vrr. U. 
PRINCX RUPERT. THR RDCCAK'KRR 
lltiMrlUd. Ikiri tiitin^.. Cr. Iki 
At. 

Juob* (W. W.t. MANV CARROtS 
SEA URCHINS. Sut«MkEiHim^ Cr 

A IfASlEB OF CR.^FT. IIIuMnM. 

ti'iilK&iitfrm. Cr. hv. V.id. 
UCHT FREIGHTS. rilii«T*»d Jt^AM 

MJAlita. Cr- %rr. u. iil. 

rUBSItIPI>KR'S«-O01KC.AV«(*WA-. 

Cr. Im^ II '.< 
AT KUMWICH PORT. ITIiuinifd TnU 

EMUm. Cr. iM. tt-U 
DLALSTOHK LANS. llLuiUMtd. jMMCt 

JUiniH. Cr. Itw. u. bj. 
0I>0 CRAFT. ISuHowd. A-mt** EMtitit 

Cr. trr. y.U. 
THRLADV or TIIB BARGE. Iltu>i»l<J 

Kit*ik SMim. Cr. tw- u. M 
SALTIIAVHlf. IlltiNntRt. inM^ ££«« 

C>. t¥t. V U. 
SAII.ORS' KNOTS. lll<Hiru*d. n«i 

JUklitm. Cr. Ih >>-«^ 

JEinw (Kfarr) THB son side 

THE BETTER SORT. Cr.tH.CK 
THE COLQEM BOWL. T*A^ CAAm 
Cr. tpf fc. 

La Quaux iWUIiunl. THSKUNCIinACK 

or W^TUI.VbTER TAiW <AAm 

THE CLOSBO SOOX. rUrJ tJuim 

THK VALLET OF THI SHADOW. 

tllMUMeL rairtf Sditun. Cr. er*. b. 

KKKtMUTIIETIIKO^K r*mf K^rirm 

Cr. »P». tl. 

THE CROOKED WAV. 4*bW (Aiu. 
Cr.lw «.. 



TUF ISVRRXO 



ilANTLK Cr. to,. 



UudoD IjAtk:. WHTTB FAUC. 

£dMtm Cn to* to 



l6 



Methuek and Company Ltvitrd 



LdSbock iSMtl) DEKP SEA WAt- 

Im. b 
Imu (Si Jebal. TBS nitST round 

Li-idl (Edn*> DERRICK VA(;CHAN, 

■MUtmutKnAFlmt- TUINXlraEU- 

C10:< : A Uuutu N vm^ ThirJS4iti^ 

Cr.Um. «•. 
BROTHERS ALL: Man Srcsin »* 

Dutch PiitjiHi I.ir> T^rd SMtif. 

C*, |« (J. 
THE PRlga or us DORIS StnmJ 

SdMm. Cr. In. W. 

■■Ckrtl>I (JiuUb R.> the DUKB'S 

■aen>UKht«lt (S). TlIK rORTUNE Or 
CltKI!>TIKA M'NAI. ^M* MJ.fnt. 
Cr. Itw. *•- 

■UM (LOMLll. COIjONKL eNDERBVS 
WIF8. FtmrA XdiHrm. Cr.Ut. hi. 

A COUNSEL OP niRPKCnOM. £««^ 
£^tlm. Cr.lM. ti. 

IHK WAOmOrSIN. SixfrmtA Editin 
Cr. tea b. 

lirKCAitis-siMA. n/agj c. •■'. »•. 

THKflATBtJE-iS BAKRlKtt Z^* "^ 

THE HI<iTORY OF SIR RICHARD 
CALMADY. Sf^fHtk SdHMk. Cr.lM b. 

Haaa (Mn. ■ II. THK PARISH 

KURSB. ^nra JCdMnf Cr.tr* ti- 
A SBKAT OP CORH. S^nmd MAtM-^ 

CnlH. tt. 
THK KKAKT-SMITKll. Jmm/ XikViM 

Cr. aw. te. 
AVltNUINO CIIILDKIUI. SMtmiBJilim,. 

Cr. »M, tr, 

■anh iRicbBrtt. THi coward be. 

II1»1> IHBCl'RTAIN. Cr.ta^ U. 
THK SUKPRISI^a HVSSAND. Sh—^ 

tJit'tm. Cr. trf. tu. 
A ROYAL INDISCRKTIOK. SMtm^ 

SJitum. C>. Ih. it. 

trVK UBN-S SHOES. ««wih/ XWkNn 
Cr. Ih. tr. 

■UrduOl ;ArahtbBM} MAKV IUMKS. 
StrntJ K^tlim. Cr. tw. Al. 

THE SQUIRE'S DAUQIITER. TAWW 
tJitim. Cr.tr*. di. 

kmod (A E- W-). CLsul>n'l^•A. 

Mnnd IConitaneo,'. A DAUGMTKR OV 

^RASCi!. rUni fJ-'i-H' Cr.trr. Ai. 

li»«««ll[W»>- VIVIKN. MnlkmM. 

TItK RACCED UKSSENCER rAi.W 

£4 Aw. Cr. Im. t*. 
FABULOUS PAKCIU. Cr.tn U 



THK OtTARnED PXAMK f jw»«« J* 

rWH. Cr. Iw*. tt. 

ouaLt.sc.rHK stf^j g^ r- i^ b 

HILL KtSt^ .^nrM £U,nsm. Cr. Mw b 

TUK COUNTESS Or MAVDv-RV; fc 

T«aoy»VAiKiL A*rM<^i/w« <in 

■•ttda CL. ri. DRIFT, 'i I r I •• JUCrwa 

C-. Hv. «l. 

RESURGAM .T»»^ XilffiM. O. tea te 

VICTORY. Cr.imt, «.. 

A CIRL OP THK PEOPLt. fft f 

HKrsy C1P.SV. lUsHnmL CP. k> 

THR HOKOVRAULB MISSi A Smh 
or AH OM>-r>tiiHy«u> Tcnrv. ntem** 
Stramd Mdieim. Cr. %rr. jc ^ 

"lflfr^'J*''V7™'- TTHssioworrn 

SflliUL trwcnMd. j«*M«« fTJ-ft' ■ 
Cr. Sm. »•. M 

HoleiwortkiHrf-]. Tlix red CfUKCt 

liliunu*^ £>iwi^ Sdttirt. Cr. b* 
y tA 

HonUn* (C E> A KIND LXT 

■ontCMMrriS. L.). COLONEL CAIX 
SnfiU £Mliem. Cr. Pw. «(, 

■orrtxN) LArUiuri. TALES or MCAS 
SIRBtlir J>M^A JUitim. Cr. k« *> 

ACHiioorTUx jaco. /vmjuwm 

THE MULE IN- THt WAU. Awrf X« 

r>n. Cr.Jp,. I,. 

DtVSRS VANITIES. Cr. |m. tt. 

H«iMt Utl. (Kfi. H. Bkarfv TUK RID 
HOL-JK. lBaitfM*4. jrffU S^^tm. 

Cr. tc*. €il. 

N«Us ddwArd). LOROC orriKE OLA 
7Ur4BJiUr^ Cr.tHL A(. ~" "^ 

OUlTMt UlfM4>. OWO BOB. THR 
GRJIY DOO UiTrENMUIR. wiT. 
FreaiutHu tS/rtmr* BaL Cr. Bm h 

Oppanhalni (S- PUUlpM). UA^IXS or 

OXVBluiai lJoJlB> A WCAVSX Ot 

WGL;]i. IIIwuvKd. AwCkfWL ITr. k» K 

THE GATR or TUR DESBRX /ta>« 

PROFIT AMD LOSS. rmirtk - '- 

Cr.lw. ««. 
THE LOKC ROAD. AarA EAKm. Ck 

THK SONO OF HYAOfTrB. AMI 
OTHER STORIES. S-irmd M^m. 

UYUOY or SHADOWS, aw^* u. 

litm Cr. Im. tj. 
Pftln Barrri. THE EXILES Or 70.00. 

i;if.-m4 t.J.itm. Cnasto*. ix. 

PArtMf LGIlMpt). PtBRRS AKD RtS 
PKOPIJL SuA KMl/m. Cr. tm. fc 



FlCTIO!* 



Vf 



MRS. rALCHIOH. K/UtEMbm. Cr^tr*. 
TKk TRAWSLATIOM Or A fiAVAOR 

TKK TRAIL or THE S«OltD. VXia- 
iT'lcd. ToM AAJk-v. Cr. Iiw. Ar. 

WMKK VALUONDCAWK lU 1-ONTIAC ; 
rtia Siai; af ■ Loai NbikUvb. ^7i<4 

AK ADVRMTUKER Of THS NORTH. 
The Lui ArfTMiuw at ■ PrMty Pien*.' 
F.-¥'!\ Jfil'l/rM. Cr. Am. (■. 

TUB SKATS OF TiPK MHJHTT. Blui- 

tm<4. Srt^miitmtk aJirLn. C'. Siv. t*. 
TtIK UATTLK OF THE .STRONG; > 

RnnuDca (i( Tn Kiocdaan. lUiwDalid. 

SUU XMHtm. C-. (r*. 1j. 
THI POMP or TIIK LAVILETTBS. 

Tk04S*ait». Cr- tm y. U. 
NOKTltBHJt LIUIII5. Ftmrtk tSlit*. 

Cr. tat. it. 

Pistup* (Mn H«ftfT 4* l«). THE 
n'KAKf. FtmnAEdilu*. Cr.^t. U. 

PAttereon (J. 14 watcheks bv rns 

SIIOKK rJurd e^tHK. Cr. In. 61. 

P<nil»rttn (lUi> thi roOTSTHps 

or A (IIKUNK. IlLiutrucd. Frmrti 
Bdaim. Cr.fr. tf. 
r CROWN THEB KUfO. [llonnMd. Cr, 

LOVE TUK BARTCSTER. A»toir o* 

T*B SkIMI. Illu.IiiXd. nUn/ SJifiim. 

O. Im*. u. iW 
THE MVBTfRV OT TUB GKF.EN 

IIEAKT. J.iir^edUim. Cr im. 6<. 
nilllpatUCEdoDl. tVlTfO TROl-UKTS. 

r*MM4aunh Cr.ttf. ti. 
CHILDRSH or THE MIST. FtJU Mdi- 

Htm. Cr. U*. ii. 
TUB nVUAM OOr. VId>ft7nQil.pU«. 

Sirtnli S*litn. Cr. tm. k. 
SOKS or THB MORIflKa. Sur^ 

KdOira. Cf . !i«l ti. 
TUB aiVBR. rUe^SMin. Cr. Im. b. 
THt AMKKICAtV rKISONBK- />b>M 

THE SeCRET WOMAN. ^»r<« £<AVfn. 

KNOCXATAVKimntK. TU^SJititn. 

Cr.tpt. 61. 
THE POKTKSUVE. AarfA XJ>'6m. Cr. 

THKPOACHSR'SWIFK. Stami XJilim. 
Cr. te«. ft.. 
; THK riRIKING ttOi;BS. SnMUEJUItm. 
' Cr. £«. ftf. 

THK FOLK AHELD. CrvtnBM. «r. 

n rHariDBdukol. SAVo TltS 
Man. titill- SJuiai,. Cr.tr*. 
6t. 
•Q'Ul.T. QuIlIwCooelO- THKWinTB 

WOLF. Amm^jE^iMm. Cr.tw &f. 
THK UAVOX or TKOV. FimUk F.Jitim. 

Cr.tn. «•. 
HBRRY-CARDSN 4itB OTxn St«>». 
Cr. 1h^ U. 



MAJOR VIGOURKUX. rJU>rf XAVjio. 

Cr: *tw. 61. 

QuarldodirMi). TOtLOruCN. Tnn. 

Ur«I »y r & Aknou). Cr. trt- ftl. 

RAWian iMmud Si>pn«j1. THE EN. 

CHASTED GARDeS. Fwmrtk SUtin. 

Cr.t^ «,. 

ni8XAgVCOLOCXIRS:«ii.0if«Wir 
or LniMI. SifBmd BMlie*. Cr.tn. «l. 

HAPFiwess. Snr^ ejiiiim. Cr.«M. u. 
Rhvi (Grseo). tkk bbidR. SKmt 

SJMtwt. Cr. •*•. «^, 

Ms* iW. PKt). ERU. ^AM/ SJi^im. 

Cr Itv, &. 
A SON or THE STATR. TttrJ Kiilttm. 

C'.*m. u.U 
A BRKAKER OP LAWS. Cr. to*, v fJ 
MRS. OALERS HUSmaSS, Uhatm.d- 

SKmUSdititm. Cr. to» U. 
TUB WICKILUdSXS. Awd E^Mm 

Cr. •*#. tr. 
KAMB OP OARLAND. TAtrJ gJiUmt. 

Cr. Sh. b. 
SPLENDID BROrUER. Ftmrth Kiitim 

Cr. On*. 4r. 

auchl* (Hra. Okvld 6.V UAM AND 
l^lllt CASSOCK. ff»W Edkum. 
Ci-.liw. If. 

R«bet-ti (CO D.). THB TIRART or TUB 
ANCIKS-l WOOD. Cr-tr, yW 

Robln« (SUcAInUl) THB CONVERT. 

TAtrJ EJ,;;.-^. Cr. ■». fr. 
KOMolmkntt ;II<ut>n Paltal. TBB 

MACl&rRAIE'S UWM CA.SK. Cr. 

Ut. u. 
Rnmn rw. ChrU. my DANISH 

SWEETHEART. nioHnlei. Ftflk 

SJUum. Cr. Ir*. 6(. 
HIS ISLAND PRINCESS. UaMnM. 

.y«n/ EdiHm. Cr. Ica **. 
ABANDOKEO. SifrndSAtitH. Cr. «•#. *<. 
UASTER ROCKATEl,LAa'8 VOVAGS. 

llkil'.lhl. fr^/i SJitL.^ Cr. ■» ti.tJ, 

Sandyi (Sydnovl JACK CARSTAIRS 
Of IHi: i'l.Wl-R IIOL'SR. lU-MWMd. 
StctK^ eMtitn. <.>. Sh. Sir. 

Sernknl iAdelln«t. THS PASSION OP 
PAUL M.MJI[.1.1SR. Cr. Iw. 6t. 

•StuUraspenrlOllTUl. UNCtS HILARY. 
Cr. *-» (.. 

SMirwiok (Mr*. Aim<n. THB tCINS- 

HAK. Iltnlntcd. T^rd SJitiM. Cr. 

TUE SEVERirfS. AarUi S/flAn. Ai. 
In 61. 

SUwart (RewUD T.I. A 90N OP THE 
EUPEROR: U(ii*> PuMcn »oii tm 
Lkb or Knio, Kia« or Sjiumhu miv 
Coisici.. Cr. »«w. «(. 

SwnrneiX^'tlnLiaralb. THE OISIIOP 

ASU rilK LADV. Srttm^ XMlltm 
Cr. tar. (* 



24t 



Metuuen and Comfanv Luiited 



nwntonXTMBpla}. KJRACt «««• 

ffirfM^blt) (BralynV THC COLUMN Or 
DCBT. Cr, *M. U. 

Torn iii«riB Tm;. ihe semtimen- 
T.u.AL>VE.:<n;KKS or jimuvivui^ 

IN iLMUL'SII. Sm»*J MdUirm. C'.tmt. 
tt. 

WBlaMnaa 'raulV THE VirK or 

NICHOLAS FUCMINa Cr cm. («. 

WatMo iH. ». MiuTtoui. rWLSTKO 

FX-.UkNTISk. IUkHuuA ri.-4 SM- 
lim. tr. tin, (f. 

TMK HIGH TOBY. r*trrf SiUiM Cr. 

A MIDSUUHXR UAV'S DRrAM. rUR< 

eMUta. Cr. tw. «<^ 
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Wblle l?Wper' LOTS AND THE WtSI 
H^f n»d£d:.Mn. Cr.tM fa. 

WlUhauoniJln. C- R^- the aotkk 

TUBE or FRINOESS SYLVIA ^sm^ 
£iiti^. C' hw. b. 
THE CASTLE OF TUB SHADOW*. 
Jko^eiilim, Cr. tMb te. 

Wtlitanson (C H. wi'i Jk. Kj. TKS 
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TKK FRINCESS PAS&KS : A R«NMM«r 
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UV FRIEND THE CltAUrmjK. ta»- 
cnirit Titri /r^fam. Cr. •iwl tt. 

LAIJY UETTV ACK05S THE WATIOL 
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T«B Moinn •* ••■". 


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KITTV ALONE. 
URITR. 


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THB BROOM SqyiRK. 

IN TU2 ROAR or THE SU. 

NOEMt. 

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31 



■onlMii (AfUorl. 



IHB WA' 
■MUt(K.). 



THI HOLS IN 



THK BSD HOUSE 



■oFril [W. E.I. HIS CRACK. 
OtLKS IMGILBY. 
THK CREDIT OF THE COUNTT. 
LORS LEONARD THE LUCKLESS. 
UATTHEW AUSTEN. 
CLARISSA rURIOSA. 

OUphmnt (Xra.). THE LADY'S WALK. 
SIR ROBSRrS FORTUNE. 
THK PRODIGALS. . 
THE TWO UARVS. 

Oppanbelm (E. P.I, HASTES Or HEN. 
Parker (Gllbapt]. THE POUP OP THE 

LAVIUITTES. 
WHEN VAUIOHD CAUE TO POHTIAC 
THE TRAIL OP THE SWORD. 

pmnbarton niaJt]. THE roOTSTEPS 

OF A THRONE 
I CROWN THEE EINa 

PhJUpotU (Bd«|. THEBUUANfiOT- 
CHILDREN OF THE HIST. 
THE POACHEK-S WIFE. 
THE RIVER. 

'Q' (A. T. QulUCF Cooshl, THS 
*HITE WOLP. 

BldgetW.Prtt). A SON OP THE STATE 

tOST PROPERTY. 

GEORGE ud THE GENERAL. 



ERR. 

RnSMll (W. CtartO. ABANDONED. 
A UARRIAGE AT SEA. 
HY DANISH SWEETHEART. 
BIS ISLAND PRINCXsa. 

btfeut JAdsUii*!. TBI MASTER OP 

BEECUWOOD. 
BALBARA'S HONEY. 
THE YELLOW DIAHOND. 
THE LOVE THAT OVERCAME. 

Stdcvlek (Mra. UtnU. THE KINS- 
MAN. 

SuFtMS (B. S.). RANDLEY CROSS. 
UR. SPONGE'S SPORTING TOUR. 
ASK UAH HA. 

Wkin»-d (Mn. L. B.I. UR. SMITH. 

COUSINS. 

THE BABY'S GRANDMOTHER. 

TROUBLESOME DAUGHTERS. 

WallAcs (Gmsrml Lmt], BEN-HUE. 
THE PAIR GOD. 

WatsoD ffl. B. Kurlott]. THBADVEN. 
TURERS. 

•CAPTAIN FORTUNE. 

WMkuULB,). PRISONERS OF WAR. 

WelU (H. 0.1. THE SEA LADY. 

Whlta (Pers^. A PASSIONATE PIL- 
GRIU. 



wnxuji CLOWI3 xro tarn, UMcrra, 



L.\NE MEDICAL LIBRARY 



To ;ivoi(l fine, this bonk should be returned on 
ur before the date last stamped below. 



MOV 25 19! I 



■ S '-* 



AU6 S 1 1966 



0lT:0l9i0 



1.964 OllTCr. sir T. 45S9fc 
046 i>ieeaBPS of oocup&tl 



A^i 



NAUE